Letters to Editor

LETTERS TO EDITOR – Response times for the provision of intrapartum epidural analgesia

Arif Hasan, ST6 Anesthetics

University Hospital of North Staffordshire, New Castle Road, North Staffordshire ST4 6QG (UK); Phone: 07970982391; E-mail: drarif16@yahoo.com

We carried out an audit in our department, to look into the response times for labor epidural requests by trainees and obstetric anesthetists, i.e. consultants/middle grades. The standard was picked from the Royal College of Anaesthetists audit recipe which states that the response time of anesthetist for labor epidural requests should be within 30 minutes and one hour in exceptional circumstances.

We retrospectively reviewed 60 case notes over a period of one year, reviewing epidurals performed by trainees, middle grades and consultants. Most of the epidurals were performed by trainees followed by middle grades. There were case notes in which no documentation was found about the grade of anesthetist or any reason for delay. The average response time within 30 minutes was 64% as compared to 80% as required by the college. The common reasons for delay being anesthetist not available, patient not ready (not in established labor), blood products not ready etc. The most obvious problem appeared to be poor documentation and the most common reason of delay was due to the anesthetist being tied up in the operating room.

We recommend that delivery suite staff must maintain accurate documentation and the patients in potential need of blood must be identified early before instituting a neuraxial blockade. This includes conditions like PIH, sepsis etc. Anesthetists should play a proactive role wherever possible and identify potential candidates for epidurals and try to intervene early to avoid unnecessary delays.

Reference: Audit recipe 2012, Royal College of Anaesthetists.