The effect of a specific protocol to shorten the decision-to-delivery
interval for emergency cesarean section
Abstract
Rationale, aims and objectives: In emergency cesarean section, time from
decision to delivery should be within 30 minutes. This study aims to
compare decision-to-delivery interval (DDI) in emergency cesarean
section before and after the implementation of a specific care process
improvement protocol (“code blue”). Methods: 300 women underwent
emergency cesarean section were included. Study and comparison group
were 150 women before and 150 women after “code blue” protocol
implementation. Medical records were reviewed for clinical information.
Timing of decision-to-delivery process was compared. Results: Maternal
age, parity, and GA at delivery were comparable between the 2 groups.
The most common indication was abnormal FHR in NICHD category III in
both groups. Median DDI was significantly shorter in study than
comparison group (22 vs. 52.5 minutes, p<0.001). In addition,
median decision-to-room and decision-to incision intervals were also
significantly shorter (8 vs. 25 minutes and 18 vs. 45 minutes,
p<0.001, respectively). Women in study group had significantly
higher rate of DDI ≤30 minutes than in comparison group (80% vs. 8%,
p<0.001). Similar significant differences of each time
interval and rate of DDI ≤30 minutes between the 2 groups were observed
regardless of decision time. Only 5 (3.3%) of women in study group had
DDI >75 minutes compared to 13 cases (25%) in comparison
group (p<0.001). Pregnancy and neonatal outcomes were
comparable between the 2 groups. Conclusion: The implementation of
“code blue” protocol for emergency cesarean section results in
significantly shorter DDI and other time intervals.