Implementation of enhanced recovery after cesarean section protocol in resource limited setting of Koidu Government Hospital, Sierra Leone 2024. A quality improvement project from evidence to reality

Title : Implementation of enhanced recovery after cesarean section protocol in resource limited setting of Koidu Government Hospital, Sierra Leone 2024. A quality improvement project from evidence to reality

Abstract:

Background: Enhanced recovery after cesarean section (ERAC) is an evidence-based, standardized and new paradigm peri-operative care program that comprises a multi-disciplinary team with the principal goal of improving quality of surgical care. The care bundles of ERAC include but are not limited to the utilization of the WHO surgical safety checklist, opioid-free analgesia, and evidence based peri-operative care.  It covers the typical causes, such as insufficient analgesia, a delayed restoration of bowel function, delayed ambulation and catheter removal that cause patients to recover from surgery more slowly and remain in the hospital longer.

Identified gap: According to our survey there are gaps in the implementation of ERAC, we found that there was low (13.3%) utilization of the WHO surgical safety checklist, only limited (15.9%) patients got opioid free analgesia, the pain was not recorded as a vital sign, there was no standardized checklist and protocol Furthermore, there was inconsistency in evidence based post-operative care.

Objective: The project aimed to improve patient outcomes, reduce complications, and enhance recovery following cesarean sections at Koidu Government Hospital 2024. 

Methodology
Implementation strategies: 3 series of PDSA cycle were implemented as key interventions included, designing evidence based and standardized protocol, checklist and guidelines on peri-operative care from SOAP, RCOG, ERAS, WHO and NICE.  Providing training and capacity building, document pain as a 6^th vital sign, and perform regional block as opioid free analgesia. Monitoring and evaluation was also undergone on daily, weekly and monthly bases.

Result: Data from 579 cesarean mothers showed significant improvements after the implementation in various aspects under different Key Performance Indicators (KPIs), Utilization of the WHO surgical safety check list found to be 95%, regional block was performed for 79% of cesarean mother, and pain was assessed and documented as 6^th vital sign for 93% of  surgical patients. Oral feeding, ambulation and catheter removal was protocoled as per the ERAC standard for all patients. Postoperative complications drastically decreased from 13.6% to 3.1%. While, the rate of readmission was kept below 1%. Furthermore, the duration of hospital stay decreased from 4.64 days to 3.12 days.

Conclusion: The Quality Improvement Project demonstrated that, the successful implementation of ERAC protocol improve the all over recovery, decrease rate of complication and hospital stay.

Keywords: Cesarean delivery, Enhanced recovery, quality improvement, patient outcome

Biography:

he is a lecturer and clinician with a strong background in perioperative medicine, clinical education, research and training in Ethiopia and Sierra Leone. Currently. he serving as an Expatriate Anesthetist at Partners in Health Sierra Leone, where his contribute to critical healthcare initiatives with a wealth of experience and a commitment to global surgery.

he is also hold the position of Associate Director of Research Ethics and Compliance at The Operating Room Global (TORG) Foundation, overseeing ethical standards in medical research. Additionally, he is dedicated Lecturer of Anesthesiology and the Vice Dean for Research at Dilla University in Ethiopia, fostering academic excellence and innovation.

Furthermore, he have won four collaborative research grants at Dilla University and published over 17 articles as PI and co-author in internationally reputable journals. he have also won a project on Enhanced recovery after surgery from Global Partner in Health (PIH) and Empowering multidisciplinary team on Safe life Through Safe surgery initiative to improve Perioperative care from Dilla University