title: Improving emergency caesarean delivery response times at a rural community hospital.
abstract: BACKGROUND
  According to national organisations, obstetric services should be able to initiate a caesarean delivery within 30 minutes of the decision to operate. This is uniquely challenging in a small, rural hospital. In 2001, the authors' hospital was unable to meet this guideline reliably. This project demonstrates how we improved our emergency caesarean delivery response time.
  
  
  METHODS
  The caesarean delivery process was examined, project co-chairs were selected and key personnel were identified. Four working groups (doctors, nurses, anaesthesia, operating room personnel) were formed to analyse and improve component parts of the process. Over time, multiple small changes were made, initially by each working group and then by the entire caesarean delivery team. Decision-to-incision time was the main outcome measure. The authors also measured standard birth statistics and tracked the percentage of caesarean deliveries that were classified as an emergency.
  
  
  RESULTS
  Forty emergency caesarean deliveries occurred during the study. The mean decision-to-incision time dropped from 31 to 20 minutes and the treatment to goal ratio increased from 0.5 to 1.0. The percentage of caesarean deliveries that were classified as emergencies dropped significantly. There has been no change in the overall caesarean delivery rate or other markers of obstetric quality.
  
  
  CONCLUSIONS
  A small, rural community hospital with limited resources can consistently meet the 30 minute decision-to-incision guideline for emergency caesarean delivery.
authors.affiliation: White River Junction, VT 05009, USA. susan.mooney@med.va.gov
authors.forename: Susan E
authors.initials: SE
authors.lastname: Mooney
authors.forename: Greg
authors.initials: G
authors.lastname: Ogrinc
authors.forename: Wendy
authors.initials: W
authors.lastname: Steadman
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000592:standards* / Q000706:statistics & numerical data; D004630:Emergencies; D005260:Female; D006764:Hospitals, Community / Q000592:standards; D006780:Hospitals, Rural / Q000592:standards*; D006801:Humans; D009513:New Hampshire; D010348:Patient Care Team / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011256:Pregnancy Outcome; D017064:Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D013996:Time and Motion Studies