Improving decision-to-delivery interval for category 1 emergency caesarean births in a tertiary hospital

Timely emergency caesarean birth is critical to maternal and neonatal outcomes. International guidance recommends a decision-to-delivery interval of within 30 min for category 1 cases, yet achieving this target is challenging in hospitals without dedicated obstetric theatres. At our institution, where emergency obstetric cases share operating theatres with other surgical specialities, local audit demonstrated inconsistent compliance with the 30-min standard. A multidisciplinary quality improvement project was undertaken using sequential plan-do-study-act cycles. Interventions focused on reinforcing appropriate categorisation, improving anaesthetists' awareness of decision-to-delivery interval expectations and introducing standardised workflow posters to support activation and escalation during emergencies. The primary outcome was the proportion of category 1 emergency caesarean births with a decision-to-delivery interval within 30 min, assessed using run-chart methodology. Following implementation, performance improved and was sustained above the institutional target of over 90% compliance with the decision-to-delivery interval within 30 min for category 1 caesarean births over a 12-month period. No maternal or neonatal adverse events or unintended theatre workflow disruptions were observed. This project demonstrates that low-cost, system-focused interventions can improve emergency obstetric timeliness in shared theatre environments and may be transferable to similar settings.