A CATEGORY ONE CAESAREAN SECTION PROCESS AT AN AUSTRALIAN TERTIARY OBSTETRIC HOSPITAL: PLANNING TO REDUCE DECISION TO DELIVERY TIME

Objective: To standardise emergency response processes to life threatening maternal and fetal situations requiring activation of a category one Caesarean section (C1CS), with the aim of reducing decision to incision (D-I) and decision to delivery (D-D) times. Design: A prospective observational study following the introduction of a streamlined C1CS process. Setting: A tertiary public obstetric hospital. Population: All women who had a C1CS process activated over a 14 month period. Methods: Data were collected prospectively on a newly developed C1CSResponse Management Plan with documentation of D-I and D-D times for multiple variables. Main outcome measures D-I and D-D times. Results: The median D-I was 11 minutes (interquartile range (IR): 7 minutes). 83% (68/82) of calls which proceeded to C1CS had D-I within 15 minutes. The median D-D was 17 minutes (IR: 9 minutes). 76% (62/82) of calls, which proceeded to C1CS, had D-D within 20 minutes and 96% within 30 minutes. Factors which significantly decreased D-I and D-D (p<0.05) included: taking verbal rather than written consent, not performing bladder catheterisation, not performing pubic clipping, and not changing women into theatre attire. Seniority of the surgeon did not affect times. Conclusions: A streamlined C1CS process can achieve D-I and D-D times well within expected international standards.