Patients at the centre of care: debriefing patients after caesarean section

[摘要] Empowering patients and working collaboratively toimprove healthcare is a focus for current healthcaredevelopment strategies. In obstetric practice, working incollaboration with women to discuss mode of delivery aftercaesarean section has been shown to impact women’schoice. A preliminary survey in our tertiary maternityunit showed 20% of women gained ‘full clarity’ withthe information they received after caesarean-sectionregarding indication, complications and impact on futuredelivery. Focus groups identified what information patientsrequired about their surgery. General practitioners (GP)highlighted a lack of communication between secondaryand primary care. Junior obstetricians surveyed feltuncertain about debriefing. The aim was to improvemonthly ‘full clarity’ scores to 30% in 6months. Our teamintroduced a debrief form, filled by the operator and keptin maternity notes. The operator verbally debriefed aspart of their current standard practice. Junior doctorspostoperatively debriefed the patient using the form. Thetriplicate form ensured both patients and primary carereceived a copy. It was anticipated that in the long term,this would provide consistent information and aid informeddecision making in subsequent pregnancies. Review of theforms’ use was undertaken weekly. Multidisciplinary inputidentified barriers to uptake. Plan, Do, Study, Act cyclespromoted the project, disseminated results, evidencedgrowing participation and rewarded consistent form use.Patient groups critiqued the form layout. Teaching aimed toimprove junior doctor confidence in debriefing discussions.Sustained participation resulted in effective form uptake.Patient ‘full clarity’ scores improved to 60% with minimalimpact on workload. Teaching successfully improved juniordoctor confidence as evidenced by increased documenteddebrief discussions. GP focus groups felt empowered tocounsel women consistently about their surgery increasingclarity for everyone. This project highlights that patientsatisfaction improves when we listen to their views andcommit to change.

[学科分类] 药学