Safeguarding early pregnancy and emergency gynaecology care in a crisis

ABSTRACT

Objective: This paper details a quality improvement project (QIP) spanning a period of 18 months (February 2020 -August 2021), during which we optimized the care delivery system in order to safeguard early pregnancy and emergency gynaecology services during the pandemic. In response to the Covid-19 pandemic, the Royal Wolverhampton Trust (New Cross hospital) in line with government guidance for infection control, relocated early pregnancy and emergency gynaecology wards to distant “non-gynae” areas of the hospital. This was challenging for junior doctors;patient care was compromised as they were seen in new wards where the nursing staff lacked the requisite training to care for them. The new locations lacked items required for clinical reviews;causing prolonged hospital stay and some increase in admissions. This QIP, highlights innovative and cost-effective measures to safeguard quality of care our patients received regardless of the location within the trust. Design: Process mapping exercise was performed to ascertain the issues, team discussions were held, human systems and human factors analysed to come up with an action plan. The action plan involved;specific teaching to members of staff who lacked the skill to care for these patients in the remote areas. We procured trolleys stocked with gynae items and consumables, a gynae bag-pack containing these items was assembled for junior doctors to take along for patient reviews. Methods: Teaching was done by Gynae consultants for staff, procurement processes were followed through to acquire trolleys for items and resources. Necessary adjustments in stages were made to determine the list of items and contents of the Gynae bag-pack. A survey was carried out to assess extent of improvement in the system, we sought support from our trust's continuing quality improvement (CQI) team who help with patient attendance data analysis. Results: Our survey showed 98% Junior doctors were satisfied with ease of access to resources at all remote locations, and felt more confident when carrying the gynae bag pack. The nurse managers and representatives gave feedbacks that they feel more confident in caring for gynae patients after the training they received. Patients received same day emergency care (SDEC) and discharged home, with associated drop in admissions from 48% to 20%. Conclusion This project was successful in utilizing systems optimization approach to safeguarding the quality of care our patients received and also ensured that health care staff safely discharged their duties in a difficult time. The improvement chain is ongoing.