Date of Graduation

Spring 5-21-2021

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Dr. Marcianna Nosek


The term decision-to-incision interval (DII) refers to the interval between when a laboring patient and their healthcare provider agree to an unscheduled surgical cesarean section (C/S) delivery and when the first incision is made in the operating room. The ideal length for this interval varies with the urgency of each case, and there is no international consensus regarding the timing. In an urban labor and delivery unit in a private hospital, examination of this interval revealed inconsistent documentation of the decision, as well as unclear guidelines on the DII for two of the three unscheduled C/S urgency levels. This quality improvement project incorporated qualitative interviews, an anonymous survey, and database analysis to examine the rates of documentation and the DII for the documented decisions over the first three months of 2021. The project concluded with a recommendation for the unit to update the DII policy to ensure clarity of timing for each of the three unscheduled C/S urgency levels, to implement a “time-out” for nurses and providers to confirm the timing of the C/S decision and its urgency, and to incorporate the framework of “just culture” into studying this issue. Finally, recommendations were provided for nursing education and a subsequent evaluation plan to ensure that the nursing staff fully understands the DII, its implications, and the unit’s policy guidelines.