Evaluation of a continuous improvement programme of enhanced recovery after caesarean delivery under neuraxial anaesthesia

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• 作者：Benjamin Deniau^a ; ^{benjdeniau@gmail.com} ; Nacima Bouhadjari^a ; ^{bouhadjari.n@live.fr} ; Valentina Faitot^a ; ^{valentina.faitot@chru-strasbourg.fr} ; Antoine Mortazavi^a ; ^{antoine.mortazavi@gmail.com} ; Gilles Kayem^b ; ^{gilles.kayem@aphp.fr} ; Laurent Mandelbrot^b ; ^{Laurent.mandelbrot@aphp.fr} ; Hawa Keita^a ; ^c ; ^{hawa.keita@lmr.aphp.fr}
• 关键词：Enhanced recovery ; Caesarean delivery ; Neuraxial anaesthesia ; Audit ; Quality process ; Multidisciplinary
• 刊名：Anaesthesia Critical Care & Pain Medicine
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：35
• 期：6
• 页码：395-399
• 全文大小：607 K
• 卷排序：35

文摘

To assess the performance of a multidisciplinary programme for enhanced recovery after caesarean delivery under neuraxial anaesthesia.Study designProspective single-centre study.MethodsProgramme in 6 steps including 3 professional practice audits based on clinical records and questioning patients: audit T0, first “existing state”, creation of a working group, drafting and implementation of a multidisciplinary rehabilitation procedure, second audit (T0 + 4 months), information about and implementation of corrective measures and a third audit (T0 + 8 months). Assessment of the performance of the continuous improvement programmes based on six measures comprising the post-caesarean rehabilitation score: duration infusion, early oral analgesia, time to removal of the urinary catheter, time to return to drinking, eating recovery time, use of carbetocin.ResultsTwo hundred and thirty-one patients were included, with 45, 64 and 122 patients at T0, T0 + 4 months and T0 + 8 months, respectively. There was a significant increase in patients who received the recovery measures (P < 0.0001 for all items) between T0 and T0 + 8 months: removal of the infusion before 24 h (49% versus 93.5%), drinking before 6 h (31% versus 55%), eating before 6 h (2% versus 38.5%), early oral analgesia before 24 h (38% versus 95%), withdrawal of the urinary catheter before 24 h (80% versus 95%), use of carbetocin (0% versus 99%).ConclusionImproved practices in rehabilitation after caesarean can be obtained by setting up a multidisciplinary programme as part of a quality approach.