Rapid Access for Patients Imminent Delivery (RAPID) Project

 

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.

Aim

To decrease DDI for Category 1 CS patients to less than 30 minutes and Category 2 CS patients to less than 60 minutes.

Method

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.

 

Results

Overall

  • 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

 

Conclusion

  • 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