title: The 30 minutes decision-to-delivery interval for 'urgent' caesarean sections: an elusive target.
abstract: The aim of this audit was to evaluate whether the '30 minute decision-to-delivery interval' for 'urgent' caesarean section has shown consistent improvement with repeated audit within this unit. The audit dataset comprised a random sample of all urgent caesarean sections carried out in 2004 classified as 'urgent', i.e. to be completed in 30 min. Nearly one-third of caesarean sections recorded on the delivery suite database as 'urgent' were incorrectly coded. A personal review of case notes was undertaken to ensure accurate data capture. Delivery suite data was analysed by post-hoc modelling of a 'normal' (Gaussian) distribution. The proportion of true 'urgent' caesarean sections completed in 30 min was 50% and some 90% of women were delivered within 40 min. The data were normally distributed, with non-random events, accounted for 25% of the variability. A model for 'urgent' caesarean section, accommodating random and non-random factors closely matched the audit data. We conclude that non-random, institutional, factors reflecting overall delivery suite activity adversely effect the decision-to-delivery interval regardless of the performance of personnel and processes within a delivery suite.
authors.affiliation: Women's Health Directorate, Darent Valley Hospital, Dartford, UK. estherandtim@yahoo.co.uk
authors.forename: K T
authors.initials: KT
authors.lastname: Moriarty
authors.forename: B
authors.initials: B
authors.lastname: Onwuzurike
authors.forename: J J
authors.initials: JJ
authors.lastname: Jones
authors.forename: M H
authors.initials: MH
authors.lastname: Jones
mesh_terms: D000773:Anesthesia, Obstetrical; D002585:Cesarean Section; D003657:Decision Making; D004630:Emergencies; D005260:Female; D006801:Humans; D011247:Pregnancy; D013997:Time Factors