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Re: 17 minute rule put into practice.From: Braun, R. Daniel (rbraun@iupui.edu)Tue Dec 8 04:58:44 1998
You could do better. It takes two things. First it takes having drills periodically with your people. Second, you need to insist on having an Operating Room in your labor and delivery unit. In my previous position at a "Community" hospital which did about 100 deliveries per month, we were able to do this on a regular basis in less than 10 minutes by the clock. The record was 7 minutes when a patient walked in the door with a prolapsed cord dangling on the floor and had her baby 7 minutes later. Oh BTW, why did you shave? The world's literature shows a lower infection rate if you don't. I haven't shaved a surgical patient in 10 years except when the nurses forget and do it on their own without an order. Dan -----Original Message----- From: ThomasInd@compuserve.com [SMTP:ThomasInd@compuserve.com] Sent: Tuesday, December 08, 1998 4:33 AM To: Multiple recipients of list Subject: 17 minute rule put into practice. I've just done a 'crash' section. I've been looking at my watch to see just how easy it was to obey this 17 minute rule in routine practice. Was called in to see a lady who at 39/40 in 2nd pregnancy had continuous severe abdo pain and a 'roller coaster' CTG. I made my initial assessment and after noting that she was 1 cm dilated and had a 'stoney hard' uterus, I made the dicision to do a C/S. At this point I looked at my watch and it was 19:23. I must have spent a good 3 - 5 minutes assessing the situation and she had already had 10 minutes of a CTG. However, to give me the benefit of the doubt we will call the decision time 19:23. With my resident and the midwifery staff I did the following; 1 - Got IV access (x2) 2 - Took bloods and arranged cross-match 3 - Catheterised and shaved 4 - Gave Zantac 5 - Consented her (for what it is worth) 6 - Spoke to the anaesthetist and theatre sister 7 - Put her on a trolley 8 - Took the trolley to theatre myself after waiting for the lift (LW on 1st floor, theatre on 2nd, all lifts on 7th floor). 9 - Wheeled her into the theatre 10 - Got changed and scrubbed 11 - Waited until the anaesthetist & paediatrician were ready. 12 - Knife to skin at 19:39. 13 - Delivery at 19:40. 14 - Abruption confirmed at C/S and happy outcome. That's 16 minutes so I just made it. I don't think I could have done it any faster. I hurried things along by playing porter as well. Furthermore, I was on labour ward (not 40 minutes away) when the call came; the anaesthetist was already in theatre; and the theatre (as always) was ready prepared. If I hadn't timed it I would have guessed that I got the baby out in 4 or 5 minutes. This 17 minute rule is a joke. I work in a unit with everything required for a quick C/S (except a theatre on LW). How can people in other units do it? -- Thomas Ind MB BS MD MRCOG St George Hospital Kogarah Sydney Australia For every complex problem there is a simple solution...and it's wrong. (H L Mencken).
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