Implementation of Day Case Management of Hyperemesis Gravidarum in Gynaecology

Quality Improvement Poster Download

Background & Problems

Nausea and vomiting of pregnancy (NVP) affects 75% of pregnant population. Most of them can be managed in primary care, with patients not responding to initial management being referred to hospital for intravenous hydration.

A local audit in 2015 showed our inpatients with severe NVP were usually healthy low risk women, the majority of whom had not received treatment in primary care.

Previously women were referred via their GP or directly attend A&E from where they are admitted to a ward bed for a period of hydration. Once discharged, patients had to go via the same referral routes for further admission if further hydration required. There was duplication of work associated with poor patient experience.

We intended to streamline the process by using system of direct referral from GP and A&E staff to a hyperemesis day case unit on ward 9A with rapid rehydration over a period of 6-8 hours and discharge home the same day. This unit would also allow open access for self-referral for a short period.

Aim

To manage at least 40% of eligible women referred with severe nausea and vomiting in pregnancy through a new day case pathway by October 2018.

Method

• Obtained approval from the service leads and risk meeting
• Guidelines, documentation proforma were drafted and revised following pilot use and feedback
• MDT meeting to agree on standard operating procedures and guidelines
• Education – ward staff, A&E staff and junior doctors via newsletter, posters, emails and departmental meeting
• Setting up of the day case bay with recliner chairs and equipment needed
• Data was collected prospectively on excel sheet and analysed using run charts

Results

In June, August, September and October 2018 we achieved our target of managing over 40% of eligible women through our day case pathway. Our major limiting factor before this was the lack availability of the bay for 5 months (used for escalation purposes). Despite this we have been successful in implementing this service.

Implications

We now have established bay on ward 9A for managing women with this condition. This will benefit the department, trust and our patients in the long run. Working with GSQIA we have learnt the QI methodologies and how to use the data effectively to demonstrate progress .We gained experience in negotiation skills and understanding the process when a new service needs to be established.

Perseverance and motivation was the key to success. We are hoping in the next couple of years this unit will be well established with direct referral system and all eligible patients will be using the day case pathway.