Reducing length of stay for women presenting as outpatients to delivery suite: a clinical practice improvement project.

Jennifer Haxton, John Hunter Hosptial
Kathleen Fahy, University of Newcastle

Abstract

Problem

Access block is an increasing problem in delivery suites due to the rising birth rates. As well as more labouring women, more women are presenting to delivery suite with pregnancy concerns (at 18 weeks gestation and over). Waiting times for women with pregnancy concerns were prolonged because, prior to the implementation of the present project, these women were required to be assessed by a midwife and then a medical officer.

Aim

The aim of this project was to safely and effectively reduce the length of stay of pregnant women presenting with pregnancy concerns who were managed as outpatients in the delivery suite.

Project setting

The project was undertaken in the Delivery Suite of a major tertiary referral hospital, NSW, Australia.

Methods

The project team used clinical practice improvement methodology (clinical audit, outpatient flow mapping, flowcharting, cause and effect diagrams, brainstorming, multi-voting and Pareto charting) to investigate and propose recommendations to improve the clinical process for this group of women.

Subjects

Five hundred thirty two pregnant women who were not in labour.

Intervention

The interventions involved developing the new clinical midwifery pathways and standing orders for the categories of cases where the midwives were able to assess, order tests and make independent clinical decisions; selecting, training and accrediting the advanced practice midwives; implementing the new clinical pathways; and evaluating the effectiveness, cost and stakeholder satisfaction levels with the changes.

Findings

The average length of stay was reduced from 178.4 to 91.5 min (49%) p < 0.001. Approximately 8 h a week of midwifery specialist time (AU$33.75 per hour) was estimated to have been saved each week during the project at a cost saving of about AU$270.00 per week. The yearly projected saving would be AU$14,040.00 per annum.

Conclusion

The use of advanced practice midwives reduced the overall length of stay for women with pregnancy concerns. There were no adverse events or complaints. Women, midwives and doctors all evaluated the change positively. These findings provide evidence to support this advanced practice midwifery model in other similar maternity services.