Creating a model to predict time intervals from induction of labor to induction of anesthesia and delivery to coordinate workload.

BACKGROUND: Induction of labor continues to become more common. We analyzed induction of labor and timing of obstetric and anesthesia work to create a model to predict the induction-anesthesia interval and the induction-delivery interval in order to co-ordinate workload to occur when staff are most available. METHODS: Patients who underwent induction of labor at a single medical center were identified and multivariable linear regression was used to model anesthesia and delivery times. Data were collected on date of birth, race/ethnicity, body mass index, gestational age, gravidity, parity, indication for labor induction, number of prior deliveries, time of induction, induction agent, cervical dilation, effacement, and fetal station on admission, date and time of anesthesia administration, date and time of delivery, and delivery type. RESULTS: A total of 1746 women met inclusion criteria. Associations which significantly influenced time from induction of labor to anesthesia and delivery included maternal age (anesthesia P <0.001, delivery P =0.002), body mass index (both P <0.001), prior vaginal delivery (both P <0.001), gestational age (anesthesia P <0.001, delivery P <0.018), simplified Bishop score (both P <0.001), and first induction agent (both P <0.001). Induction of labor of nulliparous women at 02:00 h and parous women at 04:00 or 05:00 h had the highest estimated probability of the mother having her first anesthesia encounter and delivering during optimally staffed hours when our institution's specialty personnel are most available. CONCLUSIONS: Time to obstetric and anesthesia tasks can be estimated to optimize induction of labor start times, and shift anesthesia and delivery workload to hours when staff are most available.

Prognostic significance of field response in out-of-hospital ventricular fibrillation.

We reviewed 94 cases of prehospital ventricular fibrillation (VF) to determine aspects of field response that predicted outcome. Only one of 37 patients (3 percent) failing to achieve rhythms other than VF or asystole after the first two defibrillations survived to hospital discharge compared to nine of 57 (16 percent) achieving organized rhythms by this point (p less than 0.05). None of 56 patients failing to achieve pulses prior to transport survived to hospital discharge compared to ten of 38 achieving field pulses (p less than 0.01). However, survival to discharge was not significantly different between patients who developed pulses immediately with their rhythms (5 of 17, 29 percent) and those who were defibrillated into pulseless rhythms but later developed pulses in the field (five of 21, 24 percent). Thus, for prehospital VF, the best field response identifies potential survivors prior to hospital arrival. In addition, the frequent occurrence and potentially favorable outcome of an initially pulseless rhythm necessitates reevaluation of current therapy.