Background: Timely decision-to-incision intervals (DTI) are vital in emergency surgeries across obstetrics, urology, and orthopaedics. Delays can lead to increased morbidity and mortality. Standard DTI benchmarks include 30 minutes for category 1 emergency Caesarean sections (RCOG), 60 minutes for urological emergencies (AUA), and 6 hours for open fractures (BOA).

Aim: To reduce DTI in these specialties, ensuring compliance with established clinical   standards.

Methodology: A 6 -month retrospective audit conducted at Souad kafafi university hospital between July 2022 till Jan 2023 of 143 emergency cases (67 in O&G, 34 in urology, 42 in orthopaedics) revealed DTI compliance rates of 71%, 64%, and 73%, respectively. Changes were implemented over 3 months, focusing on enhancing OR availability, staff training, and emergency protocols. A prospective re-audit was conducted over a period of 7 months post-implementation on 158 cases from May till December 2023

Results: Post-intervention, DTI compliance improved to 93% in O&G, 87% in urology, and 96% in orthopaedics, with a significant reduction in mean DTI across all departments.

Conclusion: This quality improvement project effectively reduced decision-to-incision intervals by streamlining processes and improving OR efficiency. The initiative demonstrated the value of a multidisciplinary approach in improving emergency surgical response times. Continuous monitoring is recommended to sustain these improvements.