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ELECTIVIST: a novel system to improve elective caesarean section booking

Elective caesarean sections (ELCS) vary widely in surgical complexity and are routinely performed between 39 and 40 weeks of pregnancy. Unselected ELCS lists may create clinical risk due to inappropriately complex case mixes and over-running theatre time, impacting on emergency care. Despite evidenc...

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Autores principales: Robertson, Katherine, Clacey, Joe, D’Arcy, Rhiannon, Khan, Neveen, Reddy, Aparna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135408/
https://www.ncbi.nlm.nih.gov/pubmed/30234173
http://dx.doi.org/10.1136/bmjoq-2018-000350
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author Robertson, Katherine
Clacey, Joe
D’Arcy, Rhiannon
Khan, Neveen
Reddy, Aparna
author_facet Robertson, Katherine
Clacey, Joe
D’Arcy, Rhiannon
Khan, Neveen
Reddy, Aparna
author_sort Robertson, Katherine
collection PubMed
description Elective caesarean sections (ELCS) vary widely in surgical complexity and are routinely performed between 39 and 40 weeks of pregnancy. Unselected ELCS lists may create clinical risk due to inappropriately complex case mixes and over-running theatre time, impacting on emergency care. Despite evidence that ELCS list over-run is a widespread concern for many units, there is a paucity of literature regarding effective ELCS booking systems. We designed a novel ELCS risk scoring system, ELECTIVIST, comprising a risk assessment by the booking clinician and allocation of a complexity score to each case from 1 to 6. The maximum risk score for any one patient was 6, with a maximum total score on any one ELCS list of 6 and a maximum of three cases per list. We performed a retrospective analysis of all ELCS performed in our unit in 2016 using existing booking information and theatre data to assess existing case mix complexity and theatre over-run. This showed that 36% of ELCS lists were overbooked with inappropriately complex case mix and 21% of lists over-ran with 6% impacting on emergency obstetric theatres. Assessment of the impact of ELECTIVIST on ELCS capacity prior to implementation showed that no additional capacity was required to accommodate existing complexity. At 6 months following implementation, theatre over-run was reduced to 10% and over-run impacting on emergency theatre to 1%. The requirement for extra ELCS lists to accommodate capacity reduced by 66%. ELECTIVIST is a novel system that improves ELCS booking using existing capacity and reduces theatre list over-run. It is transferable, cost neutral and could be widely applied in obstetric units.
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spelling pubmed-61354082018-09-19 ELECTIVIST: a novel system to improve elective caesarean section booking Robertson, Katherine Clacey, Joe D’Arcy, Rhiannon Khan, Neveen Reddy, Aparna BMJ Open Qual BMJ Quality Improvement report Elective caesarean sections (ELCS) vary widely in surgical complexity and are routinely performed between 39 and 40 weeks of pregnancy. Unselected ELCS lists may create clinical risk due to inappropriately complex case mixes and over-running theatre time, impacting on emergency care. Despite evidence that ELCS list over-run is a widespread concern for many units, there is a paucity of literature regarding effective ELCS booking systems. We designed a novel ELCS risk scoring system, ELECTIVIST, comprising a risk assessment by the booking clinician and allocation of a complexity score to each case from 1 to 6. The maximum risk score for any one patient was 6, with a maximum total score on any one ELCS list of 6 and a maximum of three cases per list. We performed a retrospective analysis of all ELCS performed in our unit in 2016 using existing booking information and theatre data to assess existing case mix complexity and theatre over-run. This showed that 36% of ELCS lists were overbooked with inappropriately complex case mix and 21% of lists over-ran with 6% impacting on emergency obstetric theatres. Assessment of the impact of ELECTIVIST on ELCS capacity prior to implementation showed that no additional capacity was required to accommodate existing complexity. At 6 months following implementation, theatre over-run was reduced to 10% and over-run impacting on emergency theatre to 1%. The requirement for extra ELCS lists to accommodate capacity reduced by 66%. ELECTIVIST is a novel system that improves ELCS booking using existing capacity and reduces theatre list over-run. It is transferable, cost neutral and could be widely applied in obstetric units. BMJ Publishing Group 2018-08-29 /pmc/articles/PMC6135408/ /pubmed/30234173 http://dx.doi.org/10.1136/bmjoq-2018-000350 Text en © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle BMJ Quality Improvement report
Robertson, Katherine
Clacey, Joe
D’Arcy, Rhiannon
Khan, Neveen
Reddy, Aparna
ELECTIVIST: a novel system to improve elective caesarean section booking
title ELECTIVIST: a novel system to improve elective caesarean section booking
title_full ELECTIVIST: a novel system to improve elective caesarean section booking
title_fullStr ELECTIVIST: a novel system to improve elective caesarean section booking
title_full_unstemmed ELECTIVIST: a novel system to improve elective caesarean section booking
title_short ELECTIVIST: a novel system to improve elective caesarean section booking
title_sort electivist: a novel system to improve elective caesarean section booking
topic BMJ Quality Improvement report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135408/
https://www.ncbi.nlm.nih.gov/pubmed/30234173
http://dx.doi.org/10.1136/bmjoq-2018-000350
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