A prospective study of the efficiency of the "code 333" process at the Ottawa hospital

This study evaluated the efficiency of the "Code 333" process at The Ottawa Hospital (TOH) during obstetric emergencies. A Code 333 is an overhead call made in TOH obstetrics units to activate an emergency response system. The code calls for resuscitative measures on a mother and/or a fetus and expedited delivery of a fetus considered at high risk of demise. Internationally, the recommended maximum time between the decision to deliver and actual delivery of an infant, referred to as decision-to-delivery interval (DDI), is 30 minutes.

The study was conducted over an 11-month period from February 2007 to January 2008 at The Ottawa Hospital Birthing Units (TOHBU)-Civic and General campuses. Data were collected during the code using validated documentation sheets. The day and time of decision, the indication and outcome of the code, the mode of anaesthesia used, and the condition of the baby at birth were recorded for time interval calculations.

The median DDI for 85 emergency Caesarean sections was 16 minutes. Ninety-eight percent of TOH deliveries were completed within the recommended 30 minutes. Over one third of these deliveries were completed within 15 minutes. Urgent codes had a median DDI of 13 minutes, compared with 20 minutes for less urgent codes. Time of day or day of the week did not have any effect on DDI.

The recommended DDI of 30 minutes was routinely achieved at TOHBU. DDI was prolonged in only 2% of codes during the study period, with no adverse outcome.