Bowden Sarah Joanne, Dooley William, Hanrahan Jennifer, Kanu Chidimma, Halder Suni, Cormack Caroline, O'Dwyer Sabrina, Singh Natasha
Surgery and Cancer, Imperial College London, London, UK.
Obstetrics and Gynaecology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
BMJ Open Qual. 2019 Jun 12;8(2):e000465. doi: 10.1136/bmjoq-2018-000465. eCollection 2019.
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.
术后加速康复（ERAS）旨在改善围手术期护理，加速恢复至正常生理状态并缩短住院时间（LoS）。有证据表明，择期剖宫产（ELCS）后的ERAS方案可通过更快恢复生理状态以及缩短母婴住院时间而带来益处。2013年对ELCS的基线审核显示平均住院时间为3天。我们试行一条促进术后第2天出院的ERAS出院途径，该比例从5.0%升至40.2%。19.2%的女性在第1天回家。许多女性反馈她们更希望在第1天出院。我们推测，低风险女性的第1天出院途径可能会使我们产科病房的女性和服务均受益。从2015年10月起，我们采用计划-实施-研究-改进方法制定了一条“快速通道途径”（FTP）。在2015年10月至2016年4月期间，我们前瞻性地审核了所有纳入FTP的女性的临床结局、住院时间和产妇满意度。我们定期召开多学科团队会议以进行同步分析。在术后调查中通过李克特量表分析满意度。在产前诊所中符合预先定义的低风险标准的女性被纳入。27.3%（n = 131/479）接受ELCS分娩的女性进入了FTP。FTP上76.2%的女性在第1天出院。平均住院时间降至1.31天。在第1天开始母乳喂养的女性中，94.2%在7天时仍在进行母乳喂养。在5分制李克特量表上，第7天的总体满意度为4.71。73.1%的女性报告疼痛控制良好。估计每年额外节省资金99886英镑。没有再次入院的相关病例。精心挑选的低风险女性在ELCS后第1天出院是安全且可接受的，并且满意度很高。可能会带来资金节省并改善产科病房的流程，且未发现对母乳喂养、产妇发病率或产后再次入院有不良影响。
