Improving the timeliness of emergency C-sections at Southwestern Vermont Medical Center leads to improved patient care and increased physician satisfaction.
METHODS
Increase the hospital's vaginal birth after C-section (VBAC) rate by guaranteeing compliance with ACOG's 30-minute standard.


BACKGROUND
OB and OR nursing staff and physicians, and the director of laboratory services. Process Improvement Method: Plan-Do-Check-Act. Timeline: January 1991-July 1992.


RESULTS
Lack of physician confidence in the hospital's system for handling emergency C-sections resulted in fewer trials of labor for women with a history of previous C-section. 70 percent of delays involved patient preparation for surgery, OR setup, or patient transport. Laboratory delays, not previously identified as a problem, in fact, were one of the root causes of delayed emergency C-sections.


RESULTS
By performing tests in advance, lab time has dropped from 11 minutes to zero. Patient prep time has dropped from 9 minutes on average to 2.8. 88 percent of emergency C-sections have met ACOG's 30-minute guideline.
D002585:Cesarean Section / Q000592:standards*; D002985:Clinical Protocols; D003657:Decision Making; D004630:Emergencies; D005260:Female; D005568:Forms and Records Control; D006744:Hospital Bed Capacity, 100 to 299; D006801:Humans; D008332:Management Quality Circles; D009774:Obstetrics / Q000592:standards; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration / Q000592:standards*; D010934:Planning Techniques; D011247:Pregnancy; D011340:Problem Solving; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D013996:Time and Motion Studies; D016064:Vaginal Birth after Cesarean; D014707:Vermont