Improving Elective Post Operative Gynaecology Care

R Gisby, V. Pilar, M. Ghos

BACKGROUND: An enhanced recovery post operative pathway improves the quality & experience of patient care, enabling quicker recovery and earlier discharge from hospital

AIM: Improve post operative care in elective gynaecology patients in a tertiary NHS hospital

OBJECTIVE: To develop an enhanced post operative recovery pathway that unifies & improves the delivery of post operative care

DESIGN: Resident doctors within the Gynaecology department were surveyed to establish the current knowledge base and standard of care. Following a review of national and international research, a local guideline was developed to standardise care. Following development of the guideline, the survey was repeated to assess the improvement in post operative care

METHOD: 14 resident doctors completed a survey assessing the correct clinical management of aspects of routine post operative care including: •Post operative investigations •Analgesia prescribing •Duration of VTE prophylaxis •Duration of fit note •Bladder care & management of TWOC. The survey was then repeated following development of the guideline to assess for improvement in the clinical team’s knowledge and care delivered to patients. The key qualitative outcome measure was feedback collected from the clinical team  regarding the utility & impact of the guideline

RESULTS: Prior to the introduction of the guideline, 45% of the questions in the survey were answered correctly (Range 7%-86%). Following introduction of the guideline, this improved to 77% (Range 47%-100%) Qualitative informal feedback demonstrated a lack of confidence in correct clinical management prior to the guideline due to an absence of reliable resources available and discrepancy between advice given by different senior clinicians. Feedback following its introduction was that the guideline was relevant to clinical practice, clear & easy to follow

CONCLUSIONS: The pre introduction survey highlighted the need for the development of a local guideline to standardise care. The outcome measure of improved resident doctor knowledge following review of the guideline suggests this will translate into an improvement in routine post operative care for elective gynaecology patients. Immediate actions following the survey included departmental teaching to highlight the areas of knowledge gaps. The guideline is being made available on the trust intranet. Next steps will be to complete an audit of patient notes before & after implementation of the guideline to establish if this improved knowledge base translates into improved patient outcomes, such as reduction in length of stay, the level of post of post operative interventions required and improved patient satisfaction.