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Fast-track pathway for elective caesarean section: a quality improvement initiative to promote day 1 discharge

Enhanced recovery after surgery (ERAS) aims to improve perioperative care, hasten recovery to the normal physiological state and shorten length of stay (LoS). There is evidence that ERAS programmes following elective caesarean section (ELCS) confer benefit through faster return to physiological stat...

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Autores principales: Bowden, Sarah Joanne, Dooley, William, Hanrahan, Jennifer, Kanu, Chidimma, Halder, Suni, Cormack, Caroline, O'Dwyer, Sabrina, Singh, Natasha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567941/
https://www.ncbi.nlm.nih.gov/pubmed/31259280
http://dx.doi.org/10.1136/bmjoq-2018-000465
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author Bowden, Sarah Joanne
Dooley, William
Hanrahan, Jennifer
Kanu, Chidimma
Halder, Suni
Cormack, Caroline
O'Dwyer, Sabrina
Singh, Natasha
author_facet Bowden, Sarah Joanne
Dooley, William
Hanrahan, Jennifer
Kanu, Chidimma
Halder, Suni
Cormack, Caroline
O'Dwyer, Sabrina
Singh, Natasha
author_sort Bowden, Sarah Joanne
collection PubMed
description Enhanced recovery after surgery (ERAS) aims to improve perioperative care, hasten recovery to the normal physiological state and shorten length of stay (LoS). There is evidence that ERAS programmes following elective caesarean section (ELCS) confer benefit through faster return to physiological state and reduced LoS for mother and baby. Baseline audit of ELCS in 2013 revealed a mean LoS of 3 days. We piloted an ERAS discharge pathway promoting day 2 discharge, which rose from 5.0% to 40.2%. 19.2% of women went home on day 1. Many women fed back that they would prefer day 1 discharge. We hypothesised that a day 1 discharge pathway for low-risk women could benefit both women and services at our maternity unit. From October 2015, we developed a ‘fast-track pathway’ (FTP) using a Plan-Do-Study-Act approach. Between October 2015 and April 2016, we prospectively audited clinical outcomes, LoS and maternal satisfaction from all women placed on the FTP. We held regular multidisciplinary team meetings to allow contemporaneous analysis. Satisfaction was analysed by Likert scale at postoperative surveys. Women were identified in antenatal clinic after meeting predefined low-risk criteria. 27.3% of women (n=131/479) delivering by ELCS entered the FTP. 76.2% of women on the FTP were discharged on day 1. Mean LoS fell to 1.31 days. 94.2% of women who established breast feeding at day 1 were still breast feeding at 7 days. Overall satisfaction at day 7 was 4.71 on a 5-point Likert scale. 73.1% of women reported good pain control. Additional financial savings are estimated at £99 886 annually. There were no related cases of readmission. Day 1 discharge after ELCS is safe and acceptable in carefully selected, low-risk women and has high satisfaction. There may be resultant financial savings and improved flow through a maternity unit with no detected adverse effect on breast feeding, maternal morbidity or postnatal readmissions.
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spelling pubmed-65679412019-06-28 Fast-track pathway for elective caesarean section: a quality improvement initiative to promote day 1 discharge Bowden, Sarah Joanne Dooley, William Hanrahan, Jennifer Kanu, Chidimma Halder, Suni Cormack, Caroline O'Dwyer, Sabrina Singh, Natasha BMJ Open Qual BMJ Quality Improvement report Enhanced recovery after surgery (ERAS) aims to improve perioperative care, hasten recovery to the normal physiological state and shorten length of stay (LoS). There is evidence that ERAS programmes following elective caesarean section (ELCS) confer benefit through faster return to physiological state and reduced LoS for mother and baby. Baseline audit of ELCS in 2013 revealed a mean LoS of 3 days. We piloted an ERAS discharge pathway promoting day 2 discharge, which rose from 5.0% to 40.2%. 19.2% of women went home on day 1. Many women fed back that they would prefer day 1 discharge. We hypothesised that a day 1 discharge pathway for low-risk women could benefit both women and services at our maternity unit. From October 2015, we developed a ‘fast-track pathway’ (FTP) using a Plan-Do-Study-Act approach. Between October 2015 and April 2016, we prospectively audited clinical outcomes, LoS and maternal satisfaction from all women placed on the FTP. We held regular multidisciplinary team meetings to allow contemporaneous analysis. Satisfaction was analysed by Likert scale at postoperative surveys. Women were identified in antenatal clinic after meeting predefined low-risk criteria. 27.3% of women (n=131/479) delivering by ELCS entered the FTP. 76.2% of women on the FTP were discharged on day 1. Mean LoS fell to 1.31 days. 94.2% of women who established breast feeding at day 1 were still breast feeding at 7 days. Overall satisfaction at day 7 was 4.71 on a 5-point Likert scale. 73.1% of women reported good pain control. Additional financial savings are estimated at £99 886 annually. There were no related cases of readmission. Day 1 discharge after ELCS is safe and acceptable in carefully selected, low-risk women and has high satisfaction. There may be resultant financial savings and improved flow through a maternity unit with no detected adverse effect on breast feeding, maternal morbidity or postnatal readmissions. BMJ Publishing Group 2019-06-12 /pmc/articles/PMC6567941/ /pubmed/31259280 http://dx.doi.org/10.1136/bmjoq-2018-000465 Text en © Author(s) (or their employer(s)) 2019. 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
Bowden, Sarah Joanne
Dooley, William
Hanrahan, Jennifer
Kanu, Chidimma
Halder, Suni
Cormack, Caroline
O'Dwyer, Sabrina
Singh, Natasha
Fast-track pathway for elective caesarean section: a quality improvement initiative to promote day 1 discharge
title Fast-track pathway for elective caesarean section: a quality improvement initiative to promote day 1 discharge
title_full Fast-track pathway for elective caesarean section: a quality improvement initiative to promote day 1 discharge
title_fullStr Fast-track pathway for elective caesarean section: a quality improvement initiative to promote day 1 discharge
title_full_unstemmed Fast-track pathway for elective caesarean section: a quality improvement initiative to promote day 1 discharge
title_short Fast-track pathway for elective caesarean section: a quality improvement initiative to promote day 1 discharge
title_sort fast-track pathway for elective caesarean section: a quality improvement initiative to promote day 1 discharge
topic BMJ Quality Improvement report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567941/
https://www.ncbi.nlm.nih.gov/pubmed/31259280
http://dx.doi.org/10.1136/bmjoq-2018-000465
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