Reducing emergency department length of stay for pregnant women: a quality improvement report from Ethiopia

Delayed access to emergency care can result in a decline in care quality and increased risk of morbidity and mortality. In emergency obstetrics, delay in receiving care significantly contributes to both maternal and fetal morbidity and mortality. This quality improvement project aimed to improve quality of care by reducing the number of pregnant women waiting for long periods of time in the emergency department at a public hospital in Ethiopia. A multidisciplinary quality improvement team reviewed 6 months of data and found that a median of 11 mothers per week had stayed in the emergency department for over 24 hours. Guided by the Model for Improvement, multiple plan-do-study-act cycles were conducted to analyse existing clinical pathways, test targeted changes, track progress and make data-driven decisions. This saw the number of mothers who had stayed in the emergency department for more than 24 hours reduced from 11 to four per week. Interventions included modifying the clinical pathway, expanding the cervical ripening room and developing protocols for optimising bed use. Analysing problems through the clinical pathway was an important part of this process, helping to understand existing processes and avoid steps that would not add value to patient care.