超緊急帝王切開における院内連絡体制の見直しとその効果

The Impacts of Changes in an in-Hospital Communication System for Super-emergency Cesarean Sections

要旨

　超緊急帝王切開は手術決定から30分以内の娩出が推奨される。当院では，超緊急帝王切開宣言の伝達が適切に行われず娩出に時間を要した症例を経験し，院内連絡体制の変更を行った。本研究では，院内連絡体制の変更が，宣言から娩出までの時間（娩出時間）の短縮などに有効であったかを後ろ向きに検討した。解析対象62症例のうち，夜間の娩出時間は変更前23.5±4.9分から変更後15.0±2.0分へ有意に短縮（P＝0.012），日中も短縮傾向を認め，有効性が示唆された。

　Background：In cases that involve a super-emergency cesarean section（grade A）, delivery of the infant within 30 min of the patient’s arrival at the OR is recommended. Our institution’s in-hospital communication system was revised after an incident in which the Grade A declaration was not appropriately communicated, resulting in a delayed delivery. In this study, we hypothesized that the change in our institution’s in-hospital communication system had reduced the lengths of time from declaration to admission（admission time）and from declaration to delivery（delivery time）.

　Methods：We retrospectively classified the 78 grade A super-emergency cesarean sections performed during the period 2017-2024 into two groups：the deliveries that occurred before and those that occurred after the communication system’s change. We further divided each group into daytime and nighttime delivery groups. We compared the four groups’ admission time, delivery time, and other variables.

　Results：Among the daytime cases, there were no significant differences in admission time or delivery time between before and after the communication system’s change. Among the nighttime cases, there was no significant difference in admission time between before and after the communication system’s change, but the delivery time was significantly shorter in the post-change group（15.0±2.0 min）compared to the pre-change group（23.5±4.9 min）（p＝0.018）.

　Conclusions：Establishing and implementing an appropriate in-hospital communication system can help reduce delivery times. This is particularly significant during night shifts when staff are scarce.