决策交付间隔时间：紧急剖宫产颜色编码方案的影响

Decision-delivery intervals: Impact of a colour code protocol for emergency caesareans.

作者信息

Le Mitouard Marine, Gaucher Laurent, Huissoud Cyril, Gaucherand Pascal, Rudigoz René-Charles, Dupont Corinne, Cortet Marion

机构信息

Hospices civils de Lyon, Service de Gynécologie-Obstétrique, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.

Hospices civils de Lyon, Service de Gynécologie-Obstétrique, Hôpital Femme Mère Enfant, 59 boulevard Pinel, 69500, Bron-Lyon, France; Health Services and Performance Research - HESPER EA 7425, F-69008, Lyon, France.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2020 Mar;246:29-34. doi: 10.1016/j.ejogrb.2019.12.027. Epub 2019 Dec 28.

DOI:10.1016/j.ejogrb.2019.12.027

PMID:31927407

Abstract

OBJECTIVE

Assess the impact of implementation by simple distribution of a "colour code" protocol for emergency caesareans on the course over time of the "decision-delivery interval" (DDI) and neonatal outcome.

DESIGN

Observational study in 26 maternity units of the AURORE perinatal network, conducted between October 1, 2017, and April 30, 2018. Each maternity ward́ was supposed to prospectively include 20 consecutive cases of caesareans performed either as an emergency, that is, as a code orange, or an extreme emergency, that is, code red. We compared the DDIs observed in 2017 to those in 2007 according to the degree of emergency, the maternity unit level of care, and their adherence to the protocol. Neonatal outcome in 2007 and 2017, assessed from laboratory and clinical indicators, was also compared, overall and according to the degree of emergency.

RESULTS

The DDI was significantly lower in 2017 (n = 478) than in 2007 (n = 447), regardless of the degree of emergency and the level of care (p < 0.0001). In 2017, all code red caesareans were performed in less than 15 min in level 3 maternity units compared with 73 % (p = 0.039) in 2007. Fewer than 20 % of the caesareans in the 2007 study period were performed in less than 15 min in level 1 and 2 maternity units. Today, this is the case for 83 % of these caesareans in level 2 units (p < 0.001) and 36 % in level 1 (p = 0.01). In 2017, code orange caesareans were performed in less than 30 min in 96 % of cases in level 3 units, 67 % in level 2, and 33 % in level 1, compared respectively with 67 % (p = 0.015), 25 % (p < 0.0001) and 16 % (p = 0.0003) in 2007. We did not observe any difference in the neonatal outcome between 2007 and 2017 or as a function of the DDI expected based on the caesarean colour code.

CONCLUSION

The implementation of the colour code protocols was associated with an improved DDI and better adherence to the recommendations in all 26 maternity units in this perinatal network.

摘要

目的

评估通过简单分发紧急剖宫产“颜色代码”方案对“决策-分娩间隔”（DDI）随时间变化过程及新生儿结局的影响。

设计

在2017年10月1日至2018年4月30日期间，对奥罗拉围产网络的26个产科单位进行观察性研究。每个产科病房应前瞻性纳入20例连续的剖宫产病例，这些病例要么是紧急剖宫产（即橙色代码），要么是极紧急剖宫产（即红色代码）。我们根据紧急程度、产科单位护理水平及其对方案的依从性，比较了2017年和2007年观察到的DDI。还比较了2007年和2017年根据实验室和临床指标评估的总体及按紧急程度划分的新生儿结局。

结果

无论紧急程度和护理水平如何，2017年（n = 478）的DDI均显著低于2007年（n = 447）（p < 0.0001）。在2017年，3级产科单位所有红色代码剖宫产均在15分钟内完成，而2007年这一比例为73%（p = 0.039）。在2007年研究期间，1级和2级产科单位少于20%的剖宫产在15分钟内完成。如今，2级单位此类剖宫产中有83%在15分钟内完成（p < 0.001），1级单位为36%（p = 0.01）。在2017年，3级单位96%的橙色代码剖宫产在30分钟内完成，2级单位为67%，1级单位为33%，而2007年分别为67%（p = 0.015）、25%（p < 0.0001）和16%（p = 0.0003）。我们未观察到2007年和2017年之间或根据剖宫产颜色代码预期的DDI在新生儿结局方面存在任何差异。