Reducing Decision to Incision Time Interval for Emergency Cesarean Sections: 24 Months’ Experience from Rural Sierra Leone

Abstract

Background: This study aimed at describing the changes in the completeness of documentation and changes in decision to incision time interval of emergency cesarean sections after an audit and feedback project a rural hospital in Sierra Leone. Methods: We documented and monitored the decision and incision times for emergency cesarean sections over the course of two years. Year one focused on the introduction of the project and year two focused on the continuous monitoring of the project. We compared the completeness of decision to incision data and used the 30-min benchmark as target for the decision to incision time interval. Results: A total of 762 emergency cesarean sections were included. While the completion of decision time data (72%) did not change between the two reporting periods, documentation of incision time increased from 95% to 98% (p < 0.001). Complete documentation for both decision and incision time was available for 540 (70.9%) emergency cesarean sections. The decision to incision time interval decreased from 105 min to 42 min (p < 0.001). The proportion of cesarean sections started within 30 min increased from 8.5% to 37% (p < 0.001). Conclusion: Although not all cesarean sections were performed within the 30-min threshold, the decision to incision interval decreased significantly. Improvements in documentation and routine reporting of the decision to incision time interval is recommended.

Improved maternal–fetal outcomes among emergency obstetric referrals following phone call communication at a teaching hospital in south western Uganda: a quasi-experimental study

“…We used cutoff of 30 min for a delay because to be examined and admitted takes more than just triage in our setting and also we felt that an emergency patient taking more than 30 min on the admission waiting bench would clearly separate hospital system problem from individual patient’s challenges. Time from decision to delivery by cesarean section of > 30 min was considered a delay basing on previous study [ 25 ]. Presenting problems and diagnoses for each patient were documented as recorded in the patient admission records by the clinical care team headed by the Obstetrician-Gynecologist on duty.…”