Caesarean Section: An Audit of Time‐Based Efficiency in Providing a Clinical Service

EDITORIAL COMMENT: We accepted this paper for publication to encourage all our readers who practise obstetrics to examine the situation which obtains in the hospitals where they practise obstetrics to see if emergency Caesarean sections are performed within a reasonable time of the decision to deliver abdominally being made. Lance Townsend's favourite dictum that ‘clinical scrutiny improves performance without the need for witch hunt’ is supported by the findings in this paper. It may be noted that in the author's hospital the theatre was incorporated within the labour ward which unfortunately is not the case in many institutions, even level 3 hospitals. It seems obvious that Caesarean section when ordered can be performed quicker when the patient does not need to be shifted very far especially to another floor where a journey in a lift and the availability of a theatre orderly is a requirement. Availability of anaesthetic equipment and staff in conventional operating theatres is often a factor since it is claimed that an effective service cannot additionally be provided within the labour ward environment. These considerations should be considered in all hospitals where obstetrics is practised. Having visited a number of obstetric units in Australia and abroad in small and large hospitals it is the observation of the Editor that ironically the smaller the hospital the more likely it is to be able to perform a Caesarean section within the labour ward or in an operating theatre close‐by. Summary: An audit of the time taken to deliver a baby by emergency Caesarean section was conducted at a District General Hospital in Norfolk, U.K. An assessment was made of reasons for delay in delivering a potentially compromised fetus, and a follow‐up audit showed an improvement in time‐based efficiency that was marginally significant. Median decision to deliver until delivery time in Audit 1 was 40 minutes and at follow‐up in Audit 2 was 31 minutes, p=0.068 (Wilcoxon Rank Sum Test). Discussion of these results by an interdepartmental obstetric, midwifery and anaesthetic meeting concluded that, (a) continuous audit of efficiency should be implemented and, (b) the major factor needed to effect efficient and safe delivery was clear, ‘level headed’, directive leadership by the senior medical staff on duty.