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Enhanced recovery in obstetric surgery: an executive shadowing programme perspective
Abstract Number: T-08
Abstract Type: Original Research
Introduction: Enhanced recovery in obstetric surgery (EROS) for elective cesarean delivery (CD) has gained in popularity, with next day discharge in keeping UK national guidelines. Benefits include improved maternal satisfaction and reduced length of hospital stay, which has great economic advantages. Based at a busy tertiary referral center with >6,800 deliveries and >1,400 elective CD per year, optimizing quality, efficiency and productivity (QEP) of this service is important for future sustainability. Executive shadowing is popular in the corporate world to gain managerial and leadership skills. Our institution runs such an executive shadowing programme (ESP) for residents/junior doctors, which includes undertaking a quality improvement project (QIP). We present our experience of introducing EROS, the challenges faced, and potential benefits of ESP to facilitate improvement in obstetric services.
Methods: Elective CD were audited Oct-Dec 2014 (n=50) on EROS principles including patient education, fasting times, pain relief, urinary catheter removal, mobilization, satisfaction and length of hospital stay. Action plans were communicated to midwifery and obstetrics. Re-audit occurred Oct-Dec 2016 (n=57). An ESP was attended by all fellows involved for training in QI methods and hospital board executive shadowing.
Results: The 2016 re-audit did not demonstrate improvement (Table 1). Inadequate pain control was the leading cause of delay to hospital discharge (30% of all delays).
Discussion: Relatively simple changes in clinical practice can have a big impact on QEP, but failure can be high due to poor communication and engagement. We identified barriers including poor awareness of EROS principles by patients and midwives and lack of engagement by senior clinical staff. A structured EROS programme has been planned: guidelines prepared for protocol driven care, an EROS patient companion diary, communications via meetings and presentations, liaison with senior clinical staff, and allocation of clinical 'champions'. ESP may benefit this process through knowledge of healthcare transformation, mentorship, training in improvement science, stakeholder engagement and process mapping, and ‘collective leadership’. ESP’s facilitate communication between clinicians and management, gaining credibility and momentum for a large-scale QIP. Residents/junior doctors are able to share their unique input.
1. NICE: Clinical guideline on caesarean section/http://publications.nice.org.uk/caesarean-section-cg132/guidancecare-of-the-woman-after-cs
2. M Catolico. Executive Shadowing Programme UCLH. Leadership Development for Anaesthetists (LDFA) Dec 2013 http://www.ldfa.co.uk/experiences/2013/12/2/executive-shadowing-programme-uclh