IMPROVING 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. hailemariamgetachew23@gmail.com

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IMPROVING 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.

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Grace Yei Moore-sourie Mooregrac96@gmail.com Partner in Health Sierra Leone Maternity Koidu Sierra Leone

Annie Michaelis amichaelis@pih.org Partners In Health Strategic Health Information System Boston, Massachusetts United States

Nobhojit Roy nroy@ughe.org Partners in Health, University of Global Health Equity Department of Surgery Kigali Rwanda

Manzi Anatole amanzi1@bwh.harvard.edu Partners In Health; Kigali, Rwanda and Boston Learning and quality health system strengthening Kigali and Boston United States

Sierra Leone

Oral or Poster

Enhanced recovery after cesarean section (ERAC) is an evidence-based, and standardized peri-operative care program that comprises a multi-disciplinary team with the principal goal of improving quality of surgical care. implementation of ERAC protocol in Koidu Government Hospital was low There was no standardized protocol in place; Utilization of the WHO surgical safety checklist was only 13.3%, and just 15.9% patients received opioid free analgesia, additionally, pain was not recorded as a vital sign. This project aims to improve adherence to protocol and enhance recovery following cesarean.

We employed standardized QI tools such as fish bone diagram and priority matrix for root cause analysis. Based on findings, we implemented three series of PDSA cycles. The key interventions included, designing evidence based and standardized protocol, and checklist on peri-operative care, providing training, perform regional block, and document pain as a 6th vital sign.

Post-implementation data from 689 cesarean mothers showed significant improvements under different Key Performance Indicators (KPIs). Utilization of the WHO surgical safety check list found to be 95.6 %, regional analgesia was performed for 79% of cesarean mother, and pain was assessed and documented for 97.3% of surgical patients. Oral feeding, ambulation and catheter removal was protocoled as per the ERAC standard for all patients. Postoperative complications drastically decreased from 12.71% to 5.78%. Furthermore, the duration of hospital stay decreased from 4.64 days to 3.12 days.

The quality improvement project demonstrated that, successful implementation of ERAC protocol improve the all over recovery, decrease rate of complication and hospital stay.