Boston Medical Center, and the Boston University School of Medicine, Boston, Massachusetts.
Obstet Gynecol. 2023 Jul 1;142(1):130-138. doi: 10.1097/AOG.0000000000005221. Epub 2023 Jun 7.
To standardize the preprocedure process for urgent, unscheduled cesarean deliveries to decrease the time from decision to skin incision to improve maternal and fetal outcomes.
In our quality-improvement project, we selected indications that require urgent cesarean deliveries, created a standard algorithm, then implemented a multidisciplinary process intended to reduce decision-to-incision time. This initiative was conducted from May 2019 to May 2021, with a preimplementation period from May 2019 to November 2019 (n=199), implementation period from December 2019 to September 2020 (n=283), and postimplementation period from October 2020 to May 2021 (n=160). An interrupted time series calculation was performed, with stratification by patient race and ethnicity. The primary process measure was mean decision-to-incision time. The secondary outcomes were neonatal status as measured by 5-minute Apgar score and quantitative blood loss during the cesarean delivery.
We analyzed 642 urgent cesarean deliveries; 199 were preimplementation of the standard algorithm, and 160 were postimplementation. The mean decision-to-incision time improved from 88 minutes (95% CI 75-101 min) to 50 minutes (95% CI 47-53 min) from the preimplementation period to the postimplementation period. When stratified by race and ethnicity, the mean decision-to-incision time among Black non-Hispanic patients improved from 98 minutes (95% CI 73-123 min) to 50 minutes (95% CI 45-55 min) (t=3.27, P <.01); it improved from 84 minutes (95% CI 66-103 min) to 49 minutes (95% CI 44-55 min) among Hispanic patients (t=3.51, P <.001). There was no significant improvement in decision-to-incision time among patients in other racial and ethnic groups. When the cesarean delivery was performed for fetal indications, Apgar scores were significantly higher in the postimplementation period compared with the preimplementation period (8.5 vs 8.8 beta=0.29, P <.01).
Development and implementation of a standard algorithm to expedite decision-to-incision time for unscheduled, urgent cesarean deliveries led to a significant decrease in decision-to-incision time.
规范紧急非计划性剖宫产的术前流程，以缩短从决策到切开皮肤的时间，改善母婴结局。
在我们的质量改进项目中，我们选择了需要紧急剖宫产的指征，制定了标准算法，然后实施了一项多学科流程，旨在缩短决策到切开的时间。该倡议于 2019 年 5 月至 2021 年 5 月进行，前期为 2019 年 5 月至 2019 年 11 月（n=199），实施期为 2019 年 12 月至 2020 年 9 月（n=283），后期为 2020 年 10 月至 2021 年 5 月（n=160）。采用分层中断时间序列分析方法。主要过程测量指标为平均决策到切开时间。次要结局指标为新生儿 5 分钟 Apgar 评分和剖宫产期间的出血量。
我们分析了 642 例紧急剖宫产，其中 199 例在标准算法实施前，160 例在实施后。决策到切开的平均时间从前期的 88 分钟（95%置信区间 75-101 分钟）改善至后期的 50 分钟（95%置信区间 47-53 分钟）。按种族和民族分层，黑人非西班牙裔患者的决策到切开的平均时间从 98 分钟（95%置信区间 73-123 分钟）改善至 50 分钟（95%置信区间 45-55 分钟）（t=3.27，P<.01）；西班牙裔患者的时间从 84 分钟（95%置信区间 66-103 分钟）改善至 49 分钟（95%置信区间 44-55 分钟）（t=3.51，P<.001）。其他种族和民族群体的决策到切开时间没有显著改善。当剖宫产是为了胎儿指征进行时，后期的 Apgar 评分明显高于前期（8.5 分与 8.8 分，β=0.29，P<.01）。
制定和实施加快非计划性紧急剖宫产决策到切开时间的标准算法，显著缩短了决策到切开的时间。
