ESRA Academy. Shukla B. Sep 8, 2016; 138430; 0278 Topic: REGIONAL ANAESTHESIA (RA) IN SPECIFIC SUBPOPULATIONS
Dr. Bhavin Shukla
Dr. Bhavin Shukla

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Background and Aims:

Decision to Delivery Intervals (DDI) provide  measurable auditable standard of performance in obstetrics. Increasing numbers of deliveries in the UK (700,00/year and rising) leads to an increasing risk of complications and implications. Units should strive to design guidelines that result in the shortest safely achievable DDI.  NICE recommend DDI for Cat 1 <30mins and Cat 2 <75mins whilst the RCOA and AAGBI suggest >90% of deliveries are achieved within these times

Our aim is to evaluate current practice against recommended DDI to improve service provision and patient safety.


Data collection was prospectively done using a proforma for cat 1+2 sections, looking at general details (urgency, time intervals) and specifics (anaesthetic technique, drug, doses, delays).  A survey was conducted to evaluate understanding of DDI and guidelines.


60 deliveries were recorded (21 cat1, 39 cat2) with 76% <30mins (cat 1) and 79%<75mins(cat 2). Average DDI was 23 mins(cat1) and 64mins (cat2) with various factors contributing to delays. Regional anaesthesia was successful in most (>75%cat 1, 98% cat 2) with variations of anaesthetic times and drugs for the various modalities.

The survey revealed appropriate indications for cat 1+2 sections and variation in timing for DDI (60-120mins for cat 2). 75% were aware of guidelines whilst 33% thought these were adhered to.


The data shows increased transfer times, reduced anaesthetic times and similar DDI to previous years with non-adherence to guidelines.

 Recommendations include education/training (drills/guidelines), debrief and a new protocol to enable a multidisciplinary team approach to audit and reaudit, monitoring quality improvement and service evaluation. 

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