We looked at the management of postnatal readmissions to ascertain strategies that can improve outcomes and decrease hospital stay.
60 patients were identified retrospectively over a period of 12 months, from the postnatal wards admission records, triage records and clinical incident forms at Southern General Hospital, Glasgow.
For 30/60 women (50%) the final diagnosis was infection (caesarean section wound, genital tract, urinary tract or mastitis), 10/60 women were diagnosed with uncontrolled hypertension and the rest of 20 women were investigated for suspicion of: thrombotic events, retained products of conception, urinary retention, constipation, cardiomyopathy. Four patients admitted with a diagnosis of infection returned to theatre for episiotomy repair and evacuation of retained products of conception. 23 women received intravenous antibiotics on admission, 9 had blood cultures performed and only 8 (27%) had a documented microbiology specialist opinion. The average hospital inpatient stay for this group, since delivery and including readmission, was 6.3 days.
One woman diagnosed with poorly controlled hypertension was readmitted twice and stayed in hospital in total for 15 days. Five women were reviewed only by a junior doctor, one diagnosed with uncontrolled hypertension. The average hospital stay for hypertensive patients was 7.2 days. The cost per patient of inpatient stay for one day was £825.
Genital tract infection and poorly controlled hypertension were the most common diagnoses. Prompt senior review and clearly documented management plans may decrease hospital stay.
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