Best available evidence shows that the decision to delivery interval (DDI) and emergency caesarean section (CS) should be no more than 30-60 minutes if maternal or fetal compromise is to be prevented.
Bentley Health Service (BHS) identified delays in getting Category 1 and 2 patients to theatre for emergency CS. Audit results for Sept 2018 to February 2019, showed that 22 Category 2 patients were over the recommended 60 minutes DDI and two Category 1 patients were over the 30 minute DDI for an emergency CS.
To decrease DDI for Category 1 CS patients to less than 30 minutes and Category 2 CS patients to less than 60 minutes.
Implementation of a comprehensive bundle of RAPID interventions included:
- Staff education using high fidelity simulation scenarios and power point presentations with embedded procedural videos.
- The development of a Standard Operational Procedure (SOP)
- a dedicated flexible theatre
- Assigned emergency theatre team in-hours
- Introduction of new paging distribution group for Category 1 and 2 CS
- Modifications to theatre infrastructure to create a ‘RAPID’ bay
- Streamlined after hours communication processes.
- 31% (n=258) of births (pre/post) resulted in a C Section
- 46% (n=52) required an ECS at pretest
- 33% (n=47) required an ECS at posttest.
Category 1 Patients:
- Average RAPID time from DDI to ECS was 35 mins
- Only 1 ECS was required at pretest
- 38% (n=3) of RAPID Cat 1 patients had a DDI < 30 mins.
Category 2 Patients:
- Average RAPID time from DDI to ECS was 53 mins
- 51% (n=20) of RAPID Cat 2 patients had a DDI < 60 mins
- All intervention strategies were successfully implemented.
- RAPID practice has now been established at BHS.
- Cat 1 and 2 caesarean now seen as an emergency (call 55)
- Results showed slight improvement from DDI to ECS but further embedding of RAPID is required.
Jude Cuff, Royal Perth Bentley Group, Perth WA. Judith.Cuff@health.wa.gov.au
Jo Cable, Royal Perth Bentley Group, Perth WA. Jo.Cable@health.wa.gov.au
Erin Ashbolt, Royal Perth Bentley Group, Perth WA. Erin.Ashbolt@health.wa.gov.au