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Improving emergency caesarean delivery response times at a rural community hospital
  1. Susan E Mooney1,
  2. Greg Ogrinc2,
  3. Wendy Steadman3
  1. 1White River Junction, VT, and Instructor of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire, USA
  2. 2White River Junction VA, White River Junction, VT; Assistant Professor of Community and Family Medicine and Medicine, Dartmouth Medical School, Hanover, New Hampshire, USA
  3. 3Alice Peck Day Memorial Hospital, Birthing Center, Lebanon, New Hampshire, USA
  1. Correspondence to:
 Dr S Mooney
 215 North Main Street, 11Q, White River Junction, VT 05009, USA; susan.mooney{at}


Introduction: According to national organisations, obstetric services should be able to initiate a caesarean delivery within 30 minutes of the decision to operate. This is uniquely challenging in a small, rural hospital. In 2001, the authors’ hospital was unable to meet this guideline reliably. This project demonstrates how we improved our emergency caesarean delivery response time.

Methods: The caesarean delivery process was examined, project co-chairs were selected and key personnel were identified. Four working groups (doctors, nurses, anaesthesia, operating room personnel) were formed to analyse and improve component parts of the process. Over time, multiple small changes were made, initially by each working group and then by the entire caesarean delivery team. Decision-to-incision time was the main outcome measure. The authors also measured standard birth statistics and tracked the percentage of caesarean deliveries that were classified as an emergency.

Results: Forty emergency caesarean deliveries occurred during the study. The mean decision-to-incision time dropped from 31 to 20 minutes and the treatment to goal ratio increased from 0.5 to 1.0. The percentage of caesarean deliveries that were classified as emergencies dropped significantly. There has been no change in the overall caesarean delivery rate or other markers of obstetric quality.

Conclusions: A small, rural community hospital with limited resources can consistently meet the 30 minute decision-to-incision guideline for emergency caesarean delivery.

  • AAP, American Academy of Pediatrics
  • ACOG, American College of Obstetricians and Gynecologists
  • APD, Alice Peck Day Memorial Hospital
  • CNM, Certified Nurse Midwife

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  • This material is based upon work supported by the Office of Academic Affiliations, Department of Veterans Affairs, and used facilities at the White River Junction VA.

    The opinions and findings contained herein are those of the authors and do not necessarily represent the opinions or policies of the Department of Veterans Affairs, Alice Peck Day Hospital, or Dartmouth Medical School.