Did the introduction of an electronic booking form for elective caesarean section improve compliance with guidelines for gestational age at delivery?

Abstract

Background: The Preterm Birth Collaborative in Australia aims to reduce unnecessary preterm and early-term deliveries, addressing preterm birth as a leading cause of infant mortality and long-term disability. Mater Mother's Hospital (MMH), a tertiary obstetric centre, participates in the national "Every Week Counts" initiative to minimise unnecessary early-term caesarean sections (CS). Elective CS before 39 weeks raises the risk of neonatal intensive care unit (NICU) admissions and developmental delays. MMH introduced an electronic CS booking form to improve compliance with clinical guidelines for gestational age at birth and to reduce unwarranted clinical variation.

Methods: A single-centre retrospective audit analysed CS data prior to and post implementing the electronic booking form. Data from three months pre- and three months post- were extracted from hospital records, assessing demographics, clinical indication, and compliance with national or hospital guidelines. The booking form, created with OnBase software, provided a recommended delivery window based on risk factors, requiring justification for deviations. Compliance with guidelines and rates of unplanned labour before scheduled CS were assessed.

Results: Six months of CS were reviewed, among 1,059 screened patients, 557 elective CS cases were assessed, with 283 pre-implementation and 274 post-implementation. Overall compliance with clinical guidelines improved from 90.5% to 94.5% (p = 0.06). A significant improvement was observed in patients with maternal or fetal risk factors, increasing compliance from 86.8% to 93.3% (p = 0.04). Compliance among low-risk patients remained high (95.2% pre-implementation vs. 96.8% post-implementation, p = 0.52). The proportion of CS cases presenting with spontaneous rupture of membranes (SROM) or labour before the scheduled procedure remained unchanged (23.6% vs. 24.8%, p = 0.75).

Conclusion: The introduction of an electronic CS booking form in conjunction to clinical prioritisation improved compliance with clinical guidelines for recommended gestational age at time of delivery, particularly for patients with maternal or neonatal risk factors. While the booking form did not significantly impact overall compliance or the rate of patients presenting with SROM or in labour requiring emergency CS, it highlights the valuable role of digital innovation in reducing unwarranted clinical variation. Future research should explore broader implementation across various healthcare settings.