Reducing postpartum length of stay following vaginal or cesarean delivery

Reducing postpartum length of stay following vaginal or cesarean delivery | Image Credit: © Tyler Olson - © Tyler Olson - stock.adobe.com.

Through provider and clinical staff collaboration, and a targeted initiative to discharge postpartum patients on postpartum day 1 (PPD1) or postoperative day 2 (POD2) after a vaginal or cesarean (CS) delivery, a significant and sustained decrease in mean postpartum length of stay (LOS) was observed, according to a poster featured at the 2023 Society of OB/GYN Hospitalists Annual Clinical Meeting in Chicago, Illinois.

Study investigators sought to safely reduce LOS following a cesarean or vaginal delivery at Legacy Emanuel (LE), a Level IV Maternal Care Center, maintain RN assignments amid staff shortages, improve inpatient throughput to reduce the risk of infection in a hospital setting amid the COIVD-19 pandemic, and evaluate the sustainability of a reduced postpartum LOS while recovering from the COVID-19 pandemic. Legacy Health System, which supports LE and 5 other family birth centers (FBCs), sees over 10,000 annual deliveries in Oregon and Southwest Washington State. The Randall Children’s Hospital (RCH) and LE delivers approximately 1800 of the highest-risk pregnancies in the region of the Pacific Northwest, in addition to lower-risk births, every year. According to the poster, more than “60% of the birthing patients at the RCH/LE FBC are cared for by Maternal Fetal Medicine specialists during the antepartum period.” Their respective labor and deliveries are handled by 6 OB/GYN Hospitalists.

In March of 2020, Oregon Maternal Data Center (OMDC) data revealed that the FBC at RCH/LE had the longest LOS in the Legacy System for postpartum patients that had undergone a vaginal or CS delivery. Clinical staff felt the need to reduce postpartum LOS, after learning this statistic and with the onset of the COVID-19 pandemic, which brought concern for patient and staff well-being.

Examples to prepare patients for hospital discharge, in a collaborative manner between obstetrical providers and postpartum nurses, included:

• Enhancing anticipatory guidance around expectations for discharge, starting with outpatient settings and continuing through hospital admission for induction, scheduled CS or labor, during routine delivery recover, and on the PPD floor. Communication of discharge information was facilitated through whiteboards in patient rooms.
• Using scheduled, preemptive multimodal pain management regiments.
• Ordering discharge medications the day before expected discharge date.
• Suturing all CS incisions to prevent the need for staple removal.
• Arranging temporally appropriate outpatient blood pressure follow up for patients with hypertensive disorders.

Postpartum LOS over time was reviewed each quarter from January 2020 through September 2022, and mean LOS was measured with data form OMDC. During this time, the mean postpartum LOS for vaginal deliveries decreased 28%, moving from the longest LOS in the Legacy Health System to the shortest. After CS delivery, the mean LOS decreased by 27% (3.0 days to 2.2 days), and was 10% longer than lower-risk births. In the study period, readmissions after discharge did not increase. Using the most recent data from OMDC (July 2022 to March 2023), the mean postpartum LOS for vaginal births remained the lowest at RCH/LE in the Legacy System.

The study authors concluded this collaboration and targeted approach to reduce LOS resulted in a “significant and sustained decrease in mean postpartum LOS without compromising patient safety.” Staff and resources were persevered by improving patient throughput on FBC, while reducing healthy patient exposure amid the COVID-19 pandemic.

Reference:

Smith WJ, Wray H, Roesen K, Berger W. Reducing length of stay after delivery: maintaining patient safety while preserving staff and improving family birth center throughput. 2023 Society of OB/GYN Hospitalists Annual Clinical Meeting. September 9-13, 2023. Chicago, Illinois.