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Obstet Gynecol. 2009 Mar;113(3):625-9. doi: 10.1097/AOG.0b013e31819970b8.

Time from decision to incision for cesarean deliveries at a community hospital.

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Evergreen Hospital Medical Center, Kirkland, Washington, USA.



To compare decision-to-incision times of cesarean deliveries for various indications, estimate the percentage of cesarean deliveries initiated within 30 minutes (defined as "efficient"), and assess the effect of performance improvement projects over time.


In 2004 (n=291) and 2006 (n=574) cesarean deliveries were prospectively tracked for decision-to-incision time. Information collected included indication, urgency, and reason for delay. Performance improvement addressed surgeon, anesthesiologist, operating room availability, nursing availability, and patient-related delays.


Unscheduled cesarean delivery efficiency improved from 36% in 2004 to 59% in 2006 (P<.001). Emergency cases improved from 67% to 84% (P=.07). The "Other" category was most improved over time, from 18% efficient deliveries in 2004 to 49% in 2006 (P<.001). For patients with failure to progress, efficiency improved from 33% in 2004 to 54% in 2006 (P<.001). For patients with nonreassuring fetal heart rate tracings, efficiency improved from 56% in 2004 to 76% in 2006 (P=.02). The efficiency rate for cesarean deliveries varied significantly by indication in both study years (2004, P<.001; 2006, P<.001).


Cesarean delivery efficiency varied by indication, but a data-driven hospital-based initiative successfully improved efficiency over time. Indication-based standards that address an institution's staff and structural capacity are needed to evaluate time from decision to incision.

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