Standardized Process Can Cut Decision-to-Incision Time for C-Sections

WEDNESDAY, July 14, 2023 (HealthDay News) -- Implementation of a standardized preprocedure process can reduce the decision-to-incision time for urgent cesarean deliveries, according to a study published online in the July issue of Obstetrics & Gynecology.

Lina Tibavinsky Bernal, M.D., from Boston Medical Center, and colleagues standardized the preprocedure process for urgent, unscheduled cesarean deliveries to decrease the time from decision to skin incision in a quality-improvement project. The authors selected indications that require urgent cesarean deliveries, created a standard algorithm, and implemented a multidisciplinary process. The initiative was conducted from May 2019 to May 2021. A total of 642 urgent cesarean deliveries were analyzed: 199 preimplementation of the standard algorithm, 283 during the implementation, and 160 postimplementation.

The researchers observed improvement in the mean decision-to-incision time from the preimplementation to postimplementation period, from 88 to 50 minutes. The mean decision-to-incision time improved from 98 to 50 minutes among Black non-Hispanic patients and from 84 to 49 minutes among Hispanic patients in analyses stratified by race and ethnicity. Patients in other racial and ethnic groups did not have significant improvement in decision-to-incision time. Apgar scores were significantly higher in the postimplementation period versus the preimplementation period when the cesarean delivery was performed for fetal indications (8.5 versus 8.8).

"The next step in care improvement should focus not only on identifying which patients benefit from more rapid urgent cesarean delivery and what is the recommended decision-to-incision time, but what strategies will ensure patient-centered care during these transitions," the authors write.

Abstract/Full Text