Persistence Pays Off - Closing the loop a second time on improving epidural wait times to benefit patients and anaesthetists

• Labour epidurals should be attended to within 30 minutes of request other than in exceptional circumstances, and always within one hour.¹ 
• Long waits for analgesia has negative effects on maternal mental health and contributes to birth trauma.²
• Our unit struggled to achieve this with one out of hours resident anaesthetist on multiple audits.
• Trainees reported feeling burnt out and unable to provide safe care.
• Since previous audit cycles, much work had been done with the trust and now there are always 2 resident anaesthetists out of hours, with locums sought if needed. In hours, staff are pulled from elsewhere if there are fewer than 4 anaesthetists present
• This change has only been possible through the hard work of many people over several years. 
• This has included performing regular audit cycles, multiple meetings with the trust, writing business proposals and ongoing work by the Consultant body to step down and fill gaps if necessary. 
• Future work will look at improving efficiency over handover and triaging multiple simultaneous requests or those requests made at times of high clinical acuity. It was during these times that the few longer waits occurred.