Frequency of delays in IOL processes.

Objectives
To explore local induction of labour pathways in the UK National Health Service to provide insight into current practice.
Design
National survey.
Setting
Hospital maternity services in all four nations of the UK.
Sample
Convenience sample of 71 UK maternity units.
Methods
An online cross-sectional survey was disseminated and completed via a national network of obstetrics and gynaecology specialist trainees (October 2021-March 2022). Results were analysed descriptively, with associations explored using Fisher’s Exact and ANOVA.
Main outcome measures
Induction rates, criteria, processes, delays, incidents, safety concerns.
Results
54/71 units responded (76%, 35% of UK units). Induction rate range 19.2%-53.4%, median 36.3%. 72% (39/54) had agreed induction criteria: these varied widely and were not all in national guidance. Multidisciplinary booking decision-making was not reported by 38/54 (70%). Delays reported ‘often/always’ in hospital admission for induction (19%, 10/54) and Delivery Suite transfer once induction in progress (63%, 34/54). Staffing was frequently reported cause of delay (76%, 41/54 ‘often/always’). Delays triggered incident reports in 36/54 (67%) and resulted in harm in 3/54 (6%). Induction was an area of concern (44%, 24/54); 61% (33/54) reported induction-focused quality improvement work.
Conclusions
There is substantial variation in induction rates, processes and policies across UK maternity services. Delays appear to be common and are a cause of safety concerns. With induction rates likely to increase, improved guidance and pathways are critically needed to improve safety and experience of care.

研究目标
本研究旨在探究英国国民保健服务（National Health Service, NHS）内的分娩引产本地实施路径，以明晰当前临床实践现状。

研究设计
全国性调查研究。

研究场景
英国全境四个构成国的医院产科医疗服务。

研究样本
便利抽样选取的71家英国产科单元。

研究方法
2021年10月至2022年3月期间，通过产科与妇科专科受训医师的全国协作网络，分发并回收线上横断面调查问卷。采用描述性统计方法对调研数据进行分析，借助Fisher精确检验（Fisher’s Exact Test）与方差分析（Analysis of Variance, ANOVA）探究变量间的关联关系。

主要结局指标
引产率、引产指征、操作流程、延迟事件、不良事件及安全隐患。

研究结果
共54家产科单元完成调研，有效回收率为76%，覆盖英国35%的产科单元。本次调研中引产率区间为19.2%~53.4%，中位数为36.3%。其中72%（39/54）的单元制定了统一的引产指征，该类指征差异显著且并非全部符合国家临床指南。38/54（70%）的单元未采用多学科联合决策流程开展引产相关诊疗决策。19%（10/54）的单元报告在引产患者入院环节常出现或持续存在延迟，63%（34/54）的单元在引产启动后转至分娩病区环节存在延迟。人员配置不足是报告中最常见的延迟诱因，76%（41/54）的单元表示该诱因常出现或持续存在。67%（36/54）的延迟事件触发了不良事件上报流程，6%（3/54）的延迟事件导致了患者伤害。44%（24/54）的单元将引产列为临床重点关注领域；61%（33/54）的单元开展了聚焦引产的质量改进工作。

研究结论
英国各产科医疗服务单元的引产率、操作流程与相关政策存在显著差异。引产延迟现象较为普遍，且已引发安全隐患。随着引产率持续攀升，亟需优化临床指南与实施路径，以提升分娩安全与照护体验。