Results on the primary outcome
Between 2015 and 2018, there was a significant decrease in patients with missing data (p < 0.0001) and a significant improvement in full compliance with the protocol (p < 0.0001).
For patients for whom the color code was inappropriate (patients belonging to categories 3 and 4, i.e. 69 patients in total), 15.9% were under-evaluated according to the clinical situation (reassessed color code required faster management). Figure 2 shows how compliance with the protocol changed from 2015 to 2018.
Table 4  shows compliance with color codes according to the indication for a cesarean section. There was significant agreement between the initial color code and the re-evaluated color code for each of the three color codes with a global Kappa match test of 0.82 (0.79 - 0.87).
Table 5 presents the average decision-delivery interval based on the color code and year.  There was no significant difference between the years on the decision-delivery interval regardless of the color code used. The rate of compliance of red code cesarean sections (with a decision-delivery interval of ≤15 mins) was 85.9% and increased significantly over the years to 100% in 2018 (p = 0.0020).
Most of the missing data was for color code only (83.6% of patients). For these patients, the decision-delivery interval was met for 73.7% after re-evaluation of the color code (using the indication noted on the operating report). When the decision-delivery interval was missing but the color code present, the color code was in line with the indication for 69.2% of the patients.