Decreasing Decision-to-Incision Times for Unscheduled, Urgent Cesarean Deliveries

Area of Science:

• Obstetrics and Gynecology
• Quality Improvement Science
• Patient Safety

Background:

• Urgent, unscheduled cesarean deliveries require rapid intervention to optimize maternal and fetal well-being.
• Existing preprocedure protocols can lead to delays, impacting clinical outcomes.
• Standardization of care pathways is crucial for improving efficiency in emergency obstetric procedures.

Purpose of the Study:

• To implement and evaluate a standardized algorithm for urgent, unscheduled cesarean deliveries.
• To decrease the mean time from clinical decision to skin incision (decision-to-incision time).
• To enhance maternal and fetal outcomes through a streamlined preprocedure process.

Main Methods:

• A quality improvement project utilizing an interrupted time series analysis from May 2019 to May 2021.
• Development of a multidisciplinary standard algorithm for urgent cesarean deliveries.
• Measurement of decision-to-incision time, 5-minute Apgar scores, and quantitative blood loss, stratified by patient race and ethnicity.

Main Results:

• Mean decision-to-incision time decreased from 88 minutes preimplementation to 50 minutes postimplementation.
• Significant time reductions were observed in Black non-Hispanic and Hispanic patient groups.
• Postimplementation, 5-minute Apgar scores were significantly higher for fetal indications.

Conclusions:

• A standardized algorithm effectively reduced decision-to-incision time for urgent cesarean deliveries.
• The initiative demonstrated improvements in key process and outcome measures.
• Standardization of emergency obstetric procedures is a viable strategy for enhancing patient safety and outcomes.