INTRODUCTION:Immediately prior to the COVID-19 pandemic, our public hospital implemented an enhanced recovery after surgery (ERAS) protocol. The purpose of this study was to evaluate ERAS outcomes for hysterectomy patients at our public hospital, given concerns about barriers to care in our underserved population.METHODS:A retrospective analysis was performed comparing outcomes (percent of outpatient cases, length of stay, perioperative opioids, percent of emergency department [ED] return) for hysterectomy patients for pre- and post-intervention periods (January to June in 2019 and 2021). Outcomes were compared using the Fisher exact test or t-test.RESULTS:A total of 192 preintervention and 120 post-intervention hysterectomy cases were analyzed. The majority of patients were Hispanic/Latinx in both groups (82% vs. 76%; P=.25). There was no significant change in the percentage of minimally-invasive procedures (71% vs 72%; P=1.0). The percentage of outpatient hysterectomies increased from 0% to 53% (P<.0001), and the mean length of stay (LOS) decreased from 1.6 days to 0.9 days (P<.0001). Peri-operative mean morphine milligram equivalents (MME) decreased from 78 to 54 (P≤.02). Mean post anesthesia care unit stay increased from 186 to 229 minutes (P<.01). There was no significant increase in returns to the ED <30 days (10% vs 13%; P=.36) or mean number of opioid pills prescribed (13 vs 13; P=.21).CONCLUSION:ERAS implementation for hysterectomy patients at a public hospital decreased LOS and peri-operative opioids without significantly increasing ED returns. The COVID-19 pandemic likely helped to expedite the adoption of outpatient management, which was feasible and safe in our underserved patient population.
Little is known about how impaired health literacy among women receiving perinatal care at inner city public hospitals may impact health behaviors and outcomes.METHODS: This study used the Rapid Estimate of Adult Literacy in Medicine-short form (REALM-SF) to characterize health literacy among postpartum women in a public tertiary care center and evaluate the association between health literacy and breastfeeding, prenatal care, and contraception use. RESULTS:These results reflect our interim analysis from 258 participants. The majority were black and completed high school. 94% had a 7th grade or greater reading level with 46% at high school level. 85% reported the most recent pregnancy was unplanned. There was no difference in the proportion breastfeeding at postpartum discharge by literacy level, however there was a significant increase in proportion exclusively breastfeeding at postpartum discharge among women with a higher health literacy (45% high school, 29% 7-8th grade, 8% 6th grade or less, P5.019). Women with higher health literacy were also significantly more likely to continue breastfeeding at the postpartum visit. 97% of women were using contraception at discharge, with 39% using LARC or tubal ligation. There was no difference in contraception use at discharge by health literacy. CONCLUSION:We demonstrate a correlation between health literacy and positive reproductive health outcomes including breastfeeding. Strong postpartum contraception promotion can overcome differences in health literacy. The strikingly high proportion of unplanned pregnancies among our sample deserves further evaluation.
BACKGROUND: Residents demonstrate deficiencies of knowledge and skills performing forceps-assisted vaginal delivery (FAVD) that varies by year.OBJECTIVE: To assess resident performance of FAVD and evaluate if FAVD performance can be improved with didactic instruction and simulation training.METHODS: Resident knowledge, skills and attitudes of FAVD was assessed with a written test, objective standardized assessment of technical skills (OSATS) in a simulation environment and survey. After participation in a FAVD curriculum that included lecture, PowerPoint materials, suggested readings, and simulation sessions, these measures were repeated. Data were analyzed with x 2 , analysis of variance, and Wilcoxon signed-rank tests. RESULTS: Thirty-four residents participated. In the pretest phase, marked deficiencies of FAVD knowledge and skills were evident. Written test performance was fair and improved modestly (49.9613.9% to 59.565.5% [P5.018]). Postgraduate year (PGY) did not predict performance on the written test (P5.29), however performance on OSATS varied by PGY (OSATS range PGY-1536.7%-PGY-4570.2%, P5.001). Residents exhibited fair baseline knowledge, but poor skills especially in the application of forceps and checking placement. Across all PGY groups, knowledge and skills on the OSATS (P5.001), overall performance (P5.005), and economy of time and motion (P,.001) improved after participation. The difference in performance in OSATS precurriculum and postcurriculum was 24.0% (P5.12). Residents reported improved understanding of indications (0.014), steps (P5.007), application (P5.007) and confidence (P5.010) of FAVD.BACKGROUND: To assess the effectiveness of a novel anatomic curriculum employing construction of a model of female pelvic anatomy for medical students.
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