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PL.59 Factors to Overcome Delayed Discharge Following Caesarean Section with an Enhanced Recovery Pathway
  1. RR Duggal,
  2. S Walker,
  3. M Coker,
  4. M Dudley
  1. Watford General Hospital, West Hertfordshire, UK

Abstract

Enhanced recovery (ER) pathways improve clinical outcomes, the Department of Health (DoH) suggesting several applications. Current published data within obstetrics is limited. Increased pressure on maternity beds; 39% of maternity units in England closing to admissions on one or more occasions in the year to 31 March 2007 [2], highlights a pivotal throughput parameter to benefit from an ER pathway.

Methods Survey of patients following elective caesarean section (CS) over a five-month period. Questionnaire designed against DoH guidelines [1].

Results 50 surveys completed.

100% of patients were awake in recovery with regular analgesia prescribed. Mean pain score was 0.1/10. 28% of respondents were nauseated or vomited in recovery. Mean time until discharge criteria were met was 153 minutes. Mean time for actual discharge from recovery was 213 minutes. 15% of patients were eating before discharge. 97% had a motor block on discharge. Urinary catheter remained in situ after 12 hours in 79% of patients. 100% of patients remained in hospital after 36 hours.

Discussion Patients delayed from returning to the ward may follow delayed discharges on the receiving ward, staff requirements to permit safe transfer and prolonged presence of an epidural (7%) and urinary catheters (79% after 12 hours). Promoting urinary catheter removal at 6 hours on a dedicated ‘receiving bay’ may reduce length of stay.

DoH suggests a change of culture may accompany discharges at 24 hours (providing all recovery factors have been cleared). We plan to implement a formal ER programme and re-audit in six months.

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