O.9 Going viral: enhanced recovery after planned caesarean delivery during a global pandemic

Brown, N.; McCallum, A. R.; Kearns, R.; Litchfield, K.

Introduction: The Enhanced Recovery after Obstetric Surgery in Scotland (EROSS) programme aims to reduce variation in care for women undergoing planned caesarean delivery (CD) and optimise patient experience, facilitating timely hospital discharge.1 In four years since its introduction, compliance with bundles of care has improved with day 1 discharge increasing from 5% to 32% Scotland-wide (unpublished data). The initial wave of coronarivus infections saw a predominantly consultant-delivered service, limited antenatal education and restrictions on hospital visitors. We assessed the impact of the pandemic on adherence to EROSS bundles and hospital discharge. Methods: Caldicott Guardian approval was obtained to review data regarding planned CD across three maternity units in our health board over two time periods: 18 March – 14 July 2019 (“baseline”) and 16 March – 12 July 2020 (“COVID”). Data were extracted from electronic patient records (Badgernet) and cross-referenced with theatre data (Opera). Patient characteristics, EROSS bundle adherence and postoperative length of stay (LoS) were compared. Results: A total of 1306 planned CD were reviewed. Patient characteristics were similar. Bundle adherence, where recorded, was variable. LoS was recorded in all cases – median LoS was reduced in the COVID cohort, and day 1 discharge rates increased significantly. [Formula presented] Discussion: Despite challenges posed by the coronavirus pandemic, a planned CD service was successfully maintained in our region. Continuing the trend established over the preceding 4 years, median LOS was reduced. Day 1 discharges were significantly increased despite variable bundle compliance. Are these changes a natural continuation of the embedded EROSS pathway, or have perceived barriers to discharge (eg staff shortages, limited antenatal education, non-compliance with care bundles) been superseded by concerns around exposure to coronavirus while in hospital? Further qualitative research with staff and patient surveys may provide greater insight.