Day case pathway for patients with hyperemesis: a qualitative improvement project
Fernandopulle, Navindi Doraiswamy, Jothi
Fernandopulle, Navindi
Doraiswamy, Jothi
Glos Author
Date
2021-06-06
Subject
Type
Conference Abstract
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Abstract
Implementation of a novel day case pathway for patients with severe nausea and vomiting in pregnancy: a qualitative improvement project.
Objective Severe nausea and vomiting affects 75% of pregnant women. Patients that do not respond to initial management are referred via their GP to A&E. The Gynaecology Emergency Clinic (GEC) open from 9am to 5 pm on weekdays is a novel, innovative approach to managing these patients as a day case. It was developed after a PDSA cycle identified the need for a specialist hyperemesis pathway due to an increased number of admissions not receiving appropriate care.
The main objective is to assess if patients are being referred appropriately from GP and A&E to GEC and onto the ward in line with national guidelines.
Design GEC has dedicated nursing staff and clinicians to provide patients with antiemetics, fluids and appropriate care. A ‘hyperemesis pack’ has the paperwork for prescribing and information leaflets for patients. If patients remain unwell or arrive out of hours, they are admitted to the ward.
Method Obtain records of patients from March to August 2020 who presented with nausea and vomiting in pregnancy and analyse the care they received.
Results 77 attendances were analysed. 60% of patients had attended previously. Patients that attended outside the opening hours of the clinic were 5 times more likely to be admitted. 40% patients self referred to A&E. 80% of all patients prescribed ondansetron received no counselling regarding the risk of developing cleft lip and palate. 40% patients with prolonged hyperemesis had not been prescribed thiamine. PUQE score was not recorded in 94% admissions. Ketones were not recorded in 1 in 5 patients. 6% patients it was not clear if the GP had prescribed antiemetics prior to their attendance to hospital.
Conclusion Encouraging referrals directly to the GEC clinic for the hyperemesis pathway reduces pressures on A&E, and referring patients during GEC opening hours reduces the likelihood of patients needing to be admitted overnight. This could lead to shorter waiting times for patients and improve their quality of life.
The GEC pathway will be promoted through social media awareness and informing local GPs of this service. Lectures and small group teaching will be delivered to highlight recent changes in guidelines.
Citation
Fernandopulle, N., & Doraiswamy, J. (2021). Day case pathway for patients with hyperemesis: A qualitative improvement project. BJOG: An International Journal of Obstetrics & Gynaecology, 128(Supplement S1), 16715. https://doi.org/10.1111/1471-0528.17_16715