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INTRODUCTION: Decision-to-Incision (DTI) research has investigated maternal and neonatal outcomes, while literature on decreasing DTI times remains sparse. Here we describe a quality improvement project, led by first-year medical students, aimed at reducing DTI times at a county hospital using a worksheet to guide communication during interdisciplinary huddles before each unplanned cesarean. METHODS: In 2017, medical students at Zuckerberg San Francisco General Hospital implemented a grading system to standardize the urgency of unplanned cesareans and interdisciplinary DTI huddles to assign target incision times for cesareans. Our initial intervention provided checklists for each team member. Following interviews with staff, we developed a printed communication tool to facilitate discussion around urgency, potential delays, and target incision time. Using worksheet and medical record data, we analyzed use of the DTI communication tool and DTI times pre-intervention (June-August 2016), post-checklist implementation (February-August 2017) and post-communication tool implementation (March-August 2018). RESULTS: Use of the DTI workflow in unplanned cesareans more than doubled from 20.2% to 47.7% after switching from checklists (n=74) to the communication tool (n=86). Mean DTI time decreased from 93 to 82 minutes during the same time period. Following implementation of the tool, 52.5% of unplanned cesareans occurred within five minutes of the suggested DTI times for each grade, and we observed a significant effect of urgency grade on DTI time [F(2,47)=11.3, P<.001]. CONCLUSION: The grading system adequately stratified the urgency of cesareans, while the communication tool streamlined discussion of potential delays. Guided interdisciplinary communication, not just checklists, facilitates team-based interactions critical to decreasing DTI times.