Assessment of compliance with a color coded protocol for non-elective
cesarean section in a maternity ward in France.
Abstract
Purpose: The aim of a color coded protocol for non-elective
cesarean-sections is to improve decision-delivery interval by better
organization of care in a maternity unit. We set out to assess
compliance of a color coded protocol and its impact on maternal and
neonatal outcomes since its implementation in our maternity ward.
Materials and methods: This was a retrospective study including a sample
of 200 patients per year who underwent an non-elective cesarean section
delivery in Rennes University Hospital from January 1, 2015 to December
31, 2018. Patients were grouped by year and by color code (red, orange
or green). The main outcome was compliance with the protocol (color code
in accordance with indication for cesarean section) and compliance with
the corresponding decision-delivery interval. Secondary outcomes were
maternal and neonatal outcomes. The statistical tests performed were
Fisher’s test for qualitative parameters and Kruskal-Wallis test for
quantitative parameters. Results: Eight hundred patients were included
during the study period. There was no significant difference in patient
characteristics over the years. There was a significant improvement in
protocol compliance: full compliance increased from 22.4% in 2015 to
76.5% in 2018 (p<0.0001). No difference was observed in the
decision-delivery interval overall but compliance with the 15-minute
decision-delivery interval imposed by a red coded protocol increased
between 2015 and 2018 (p=0.0020). Conclusion: We observed a significant
improvement in compliance with the color coded protocol between 2015 and
2018 and in the 15-minute decision-delivery deadline for the red code.