Recommendation ID
CG132/1
Question
Decision-to-delivery interval (category 1 urgency):- What factors influence the decision-to-delivery interval when there is a category 1 level of urgency for Caesarean Section (CS)?
Factors to be investigated could include:
• staff grade/level of experience
• skill mix in the multidisciplinary team
• task allocation
• methods of communication
• time of day
• availability of ongoing staff training about emergency procedures and levels of attendance.
The research could be conducted using simulation methods and video observation to determine what factors influence the decision-to-delivery interval for category 1 CS. The videos could also be used to train staff.
Any explanatory notes
(if applicable)
Why this is important:- 'Crash' Caesarean Section (CS) is a psychologically traumatic event for women and their partners and is also stressful for clinical staff. Staff and resources may have to be obtained from other areas of clinical care. This should be undertaken as efficiently and effectively as possible, minimising anxiety and
ensuring the safety of the mother and her baby. For category 1 CS there is a recognised urgency to deliver as quickly as is reasonably possible. The majority of research in this area is quantitative and looks at the impact of the decision-to delivery interval on various aspects of fetal and maternal outcomes rather than the interplay of
factors that can affect this time period itself. Much of this evidence is retrospective. Although some work has been conducted in the UK to examine where the systematic delays lie and how to avoid them (Tuffnell et al. 2001), more work is needed to determine how to optimise the decision-to-delivery interval. This work should use qualitative as well as quantitative research methods to assess which factors influence the decision-to-delivery interval for a category 1 CS. Evaluation of these factors could be used to inform future NICE guidance, for example, specific
guidance for management of category 1 CS. Such information could also be used by hospitals for maternity services planning, and at a team level would assist with audit and ongoing evaluation and training of the multidisciplinary team. A large amount of NHS and other state funding is used to provide continuing care for infants who are disabled as a result of birth asphyxia and in providing lifelong support for the child and their family. In addition, large sums of public money are spent on litigation and compensation in some of these cases through the Clinical Negligence Scheme for Trusts (CNST). If research helped to minimise the impact of birth asphyxia this would reduce the costs of continuing care to the state and the burden to the child, their family and the wider community.More realistic and more relevant expectations for the decision-to-delivery interval based on evidence would inform debate in the legal system and may help to reduce the cost to the state of related litigation.

Source guidance details

Comes from guidance
Caesarean section
Number
CG132
Date issued
November 2011

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No