title: The effects of resource improvement on decision-to-delivery times for cesarean deliveries in a Ghanaian regional hospital.
abstract: OBJECTIVE
  To evaluate the effects of having a dedicated obstetric operating room (OR) on the decision-to-delivery interval (DDI) in a large referral hospital in Ghana.
  
  
  METHODS
  An observational study was undertaken of all patients undergoing cesarean delivery at Ridge Regional Hospital, Accra, before (pre-OR; August-September 2011) and after (post-OR; August-September 2012) introduction of an obstetric OR. The primary outcome was the DDI.
  
  
  RESULTS
  In total, 581 cesareans were performed in the pre-OR period and 574 in the post-OR period. Overall, the median DDI decreased from 259 min (interquartile range [IQR] 161-432) in the pre-OR period to 195 min (IQR 138-319) in the post-OR period (P<0.001). DDI was lower in the post-OR period than in the pre-OR period for both emergency (175 min [IQR 126-241] vs 220 min [IQR 146-315]; P<0.001) and elective (1828 min [IQR 1432-2985] vs 4291 min [IQR 2992-5862]; P<0.001) cesarean deliveries. Only one emergency cesarean-in the post-OR period-was conducted within the recommended 30-minute timeframe.
  
  
  CONCLUSIONS
  An obstetric OR lowered the DDI for cesarean delivery; however, a realistic timeframe for emergency cesareans in low-income countries remains to be determined.
authors.affiliation: Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Onyi
authors.initials: O
authors.lastname: Onuoha
authors.affiliation: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Rohit
authors.initials: R
authors.lastname: Ramaswamy
authors.affiliation: Department of Obstetrics and Gynecology, Ridge Regional Hospital, Accra, Ghana.
authors.forename: Emmanuel K
authors.initials: EK
authors.lastname: Srofenyoh
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Sung M
authors.initials: SM
authors.lastname: Kim
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, NC, USA. Electronic address: mowen@wakehealth.edu.
authors.forename: Medge D
authors.initials: MD
authors.lastname: Owen
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D003657:Decision Making; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D004630:Emergencies; D005260:Female; D005869:Ghana; D006801:Humans; D009873:Operating Rooms / Q000458:organization & administration*; D011247:Pregnancy; D013997:Time Factors; D055815:Young Adult
keywords: Cesarean delivery; Decision-to-delivery interval; Neonatal outcomes; Sub-Saharan Africa