title: Evaluation of a continuous improvement programme of enhanced recovery after caesarean delivery under neuraxial anaesthesia.
abstract: OBJECTIVE
  To assess the performance of a multidisciplinary programme for enhanced recovery after caesarean delivery under neuraxial anaesthesia.
  
  
  METHODS
  Prospective single-centre study.
  
  
  METHODS
  Programme in 6 steps including 3 professional practice audits based on clinical records and questioning patients: audit T0, first "existing state", creation of a working group, drafting and implementation of a multidisciplinary rehabilitation procedure, second audit (T0+4 months), information about and implementation of corrective measures and a third audit (T0+8 months). Assessment of the performance of the continuous improvement programmes based on six measures comprising the post-caesarean rehabilitation score: duration infusion, early oral analgesia, time to removal of the urinary catheter, time to return to drinking, eating recovery time, use of carbetocin.
  
  
  RESULTS
  Two hundred and thirty-one patients were included, with 45, 64 and 122 patients at T0, T0+4 months and T0+8 months, respectively. There was a significant increase in patients who received the recovery measures (P<0.0001 for all items) between T0 and T0+8 months: removal of the infusion before 24h (49% versus 93.5%), drinking before 6h (31% versus 55%), eating before 6h (2% versus 38.5%), early oral analgesia before 24h (38% versus 95%), withdrawal of the urinary catheter before 24h (80% versus 95%), use of carbetocin (0% versus 99%).
  
  
  CONCLUSIONS
  Improved practices in rehabilitation after caesarean can be obtained by setting up a multidisciplinary programme as part of a quality approach.
authors.affiliation: Service d'Anesthésie, CHU Louis-Mourier, AP-HP, Université Paris 7, 178, rue des Renouillers, 92700 Colombes, France. Electronic address: benjdeniau@gmail.com.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Deniau
authors.affiliation: Service d'Anesthésie, CHU Louis-Mourier, AP-HP, Université Paris 7, 178, rue des Renouillers, 92700 Colombes, France. Electronic address: bouhadjari.n@live.fr.
authors.forename: Nacima
authors.initials: N
authors.lastname: Bouhadjari
authors.affiliation: Service d'Anesthésie, CHU Louis-Mourier, AP-HP, Université Paris 7, 178, rue des Renouillers, 92700 Colombes, France. Electronic address: valentina.faitot@chru-strasbourg.fr.
authors.forename: Valentina
authors.initials: V
authors.lastname: Faitot
authors.affiliation: Service d'Anesthésie, CHU Louis-Mourier, AP-HP, Université Paris 7, 178, rue des Renouillers, 92700 Colombes, France. Electronic address: antoine.mortazavi@gmail.com.
authors.forename: Antoine
authors.initials: A
authors.lastname: Mortazavi
authors.affiliation: Service de Gynécologie-Obstétrique, CHU Louis-Mourier, AP-HP, Université Paris 7, 178, rue des Renouillers, 92700 Colombes, France. Electronic address: gilles.kayem@aphp.fr.
authors.forename: Gilles
authors.initials: G
authors.lastname: Kayem
authors.affiliation: Service de Gynécologie-Obstétrique, CHU Louis-Mourier, AP-HP, Université Paris 7, 178, rue des Renouillers, 92700 Colombes, France. Electronic address: Laurent.mandelbrot@aphp.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Mandelbrot
authors.affiliation: Service d'Anesthésie, CHU Louis-Mourier, AP-HP, Université Paris 7, 178, rue des Renouillers, 92700 Colombes, France; Université Paris Diderot, Sorbonne Paris Cité, EA Recherche Clinique coordonnée ville-hôpital, Méthodologies et Société (REMES), 75010 Paris, France. Electronic address: hawa.keita@lmr.aphp.fr.
authors.forename: Hawa
authors.initials: H
authors.lastname: Keita
mesh_terms: D000328:Adult; D000762:Anesthesia Recovery Period; D000773:Anesthesia, Obstetrical; D002585:Cesarean Section / Q000379:methods* / Q000534:rehabilitation*; D020878:Device Removal; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008485:Medical Audit; D009407:Nerve Block; D010120:Oxytocics / Q000627:therapeutic use; D010121:Oxytocin / Q000031:analogs & derivatives / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy; D011182:Postoperative Care; D011247:Pregnancy; D015397:Program Evaluation; D011446:Prospective Studies; D017749:Total Quality Management; D014546:Urinary Catheterization
chemical_list: D010120:Oxytocics; D010121:Oxytocin; C020731:carbetocin
keywords: Audit; Caesarean delivery; Enhanced recovery; Multidisciplinary; Neuraxial anaesthesia; Quality process