An initiative to improve theatre recovery care for obstetric patients: an obstetric checklist and escalation pathway

Abstract

Background: High-quality care of the obstetric patient should extend beyond hospital discharge, and not just until delivery of the baby. A preliminary survey of our theatre recovery staff revealed that 44% had never received training specific to the obstetric patient, and 50% had never received Trust-training specific to the obstetric patient. With obstetric patients representing a high proportion of the general theatre recovery workload (30%), we highlighted this as an area for improvement. Unfortunately, one patient had eclamptic seizures upon discharge to the ward after the onset of raised blood pressure post-delivery in theatre recovery. Methods: We designed a recovery checklist, detailing the pertinent points regarding intra-recovery care, and handover upon arrival to and discharge from recovery of the obstetric patient. The risk factors, abnormal physiological parameters, and abnormal examination findings help staff recognise the deteriorating patient (relating to conditions including maternal sepsis, pre-eclampsia,1 major haemorrhage,2 and epidural haematoma3), and provide an appropriate pathway for escalation. This was launched in conjunction with a 1-h teaching session (performed three times to capture all staff) to reinforce learning around these topics, and aid appropriate utilisation of the checklist. Staff surveys before and after intervention were performed to assess their confidence levels in identifying obstetric patients with these conditions. Results: Post-intervention confidence levels in recognition of particular obstetric conditions showed a general increase. More staff were very or extremely confident in recognising a bleeding patient (75% pre vs 100% post), maternal sepsis (63% pre vs 81% post), pre-eclampsia (38% pre vs 75% post), and epidural haematoma (31% pre vs 63% post). Overall, feedback was positive with 100% of staff finding the checklist and teaching very or extremely useful. Comments included requests for ‘more teaching for recovery staff’ and longer teaching sessions to ‘discuss past experiences for reflection’. Conclusions: The introduction of our checklist, supplemented by additional teaching, has markedly improved the confidence levels of our recovery staff when managing obstetric patients, particularly pertaining to recognition of pre-eclampsia and epidural haematoma. The checklist will serve as an aide memoire to support good multidisciplinary care, including handover and communication to both ward staff at discharge and to senior staff in the event of a deteriorating patient. This will improve our postoperative recovery care of obstetric patients and reduce the incidence of obstetric emergencies occurring on the postnatal ward. 1.Burton GJ, Redman CR, Roberts JM, Moffett A. BMJ 2019; 366: I23812.Royal College of Obstetricians. BJOG 2016; 124: e106–493.Yentis SM, Lucas DN, Brigante L, et al. Anaesthesia 2020; 75: 913–9