A specific protocol to shorten the decision-to-delivery interval for emergency caesarean section

The achievement of recommended decision-to-delivery interval (DDI) of ≤30 minutes in emergency caesarean section (CS) is relatively low in developing countries. This study was aimed to compare DDI in emergency CS before and after the implementation of a specific care process improvement protocol, called 'code blue'. A total of 300 women underwent emergency CS were included; 150 consecutive cases before (during 2015-2016) and the other 150 consecutive cases after (during 2017-2018) 'code blue' implementation. Timing of decision-to-delivery process was compared. The results showed that median DDI was significantly shorter after 'code blue' implementation (22 vs. 52.5 minutes, p<.001). DDI of ≤30 minutes was achieved in 80% of the women under 'code blue' compared to 8% before implementation (p<.001). Significant improvements were observed regardless of decision time. Pregnancy and neonatal outcomes were comparable between the two periods. The implementation of 'code blue' protocol for emergency CS results in significantly shorter DDI and other time intervals.Impact StatementWhat is already known on this subject? Achievement of recommended decision-to-delivery interval (DDI) of ≤30 minutes in emergency caesarean section is relatively low in developing countries. Various setting-specific care improvement processes have been reported to shorten DDI.What do the results of this study add? A multidisciplinary care improvement process ('code blue') that developed according to specific evidence and based on a hospital's context can significantly shorten DDI as well as other time intervals in women requiring emergency CS.What are the implications of these findings for clinical practice and/or further research? The 'code blue' protocol could be used as a model for other hospitals and health care settings to develop their own specific quality improvement process in order to shorten DDI for emergency CS. Collaboration and communication between all staff members could help in better identification of significant barriers as well as development of appropriate solutions. Further studies are also needed to determine whether the shortened DDI could improve neonatal outcomes.