title: [Shortened hospital stay for elective cesarean section after initiation of a fast-track program and midwifery home-care].
abstract: To audit whether hospital stay shortened without increasing readmissions after implementation of fast-track methodology for elective cesarean section and characterize what influences length of stay.
  
  
  
  A fast-track program was initiated in November 2008, with a one year clinical audit and satisfaction survey. Discharge criteria were predefined and midwife home visits included if discharge was within 48 hours. Hospital stay by parity for women with elective section for singleton pregnancy between 1.11. 2008 - 31.10. 2009 (n=213, fast-track 182) was compared to 2003 (n=199) and 2007 (n=183). Readmissions and outpatient visits 2007 and 2008-9 were counted. Reasons for longer stay were recorded in fast-track, and body mass index.
  
  
  
  Median hospital stay decreased significantly from 81 to 52 hours between 2007 and 2008-9. Readmissions were four in each period and outpatient visit rates similar. In 2008-9, 66% of all women were discharged within 48 hours. Women in the fast-track program were satisfied with early discharge. Hospital stay for parous women was shorter in 2007 compared to 2003, but unchanged for nulliparas. Parity had a minimal influence on length of stay in 2008-9, although nulliparous women ≤ 25 years were more likely to stay >48 hours. Body mass index did not correlate with length of stay. Pain was rarely the reason for a longer stay in the fast-track program and 90% were satisfied with pain-medication after discharge.
  
  
  
  Most healthy women can be discharged early after singleton birth by elective cesarean, without increasing readmissions.
authors.affiliation: johagun@bjarni.muna.is
authors.forename: Johanna
authors.initials: J
authors.lastname: Gunnarsdottir
authors.forename: Thorbjörg Edda
authors.initials: TE
authors.lastname: Bjornsdottir
authors.forename: Thorhallur Ingi
authors.initials: TI
authors.lastname: Halldorsson
authors.forename: Gudrun
authors.initials: G
authors.lastname: Halldorsdottir
authors.forename: Reynir Tomas
authors.initials: RT
authors.lastname: Geirsson
mesh_terms: D000553:Ambulatory Care; D002585:Cesarean Section; D054869:Clinical Audit; D017558:Elective Surgical Procedures; D005260:Female; D019538:Health Care Surveys; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007055:Iceland; D007902:Length of Stay; D008880:Midwifery; D010298:Parity; D010351:Patient Discharge; D010359:Patient Readmission; D017060:Patient Satisfaction; D011247:Pregnancy; D015397:Program Evaluation; D013997:Time Factors