The Case for Day Case: Reduced Inpatient Stays with the use of Day Case Management in Hyperemesis Study

Author(s): Neil Ryan*, Charlie Zhou, Thomas Sewell, Sarah Ingamells, Paul Zinger, Jane Mears, Lalrinawmi Lalrinawmi.

Journal Name: Current Women`s Health Reviews

Volume 15 , Issue 2 , 2019

Become EABM
Become Reviewer

Graphical Abstract:


Abstract:

Background: Hyperemesis gravidarum (HG) is a major health burden affecting between 1-2% of all pregnancies. The sequelae of the condition can be fatal. There is current equipoise as to how best to manage the condition; that is inpatient versus outpatient management.

Objective: This study investigated the total length of stay for patients diagnosed with HG, comparing those who were managed as inpatients as opposed to those managed in a day case setting. A case control methodology was utilized. Two tertiary referral centres for HG of similar size and demographic were selected. One preferentially used day case management. The other uses inpatient management.

Results: In total 61 day, case managed patients and 91 inpatient managed patients were recruited to the study. Adjusting for readmission, total length of stay was 4.08 days for inpatient managed patients compared to 0.39 days for day case managed patients (p=0.0002).

Conclusion: Day case managed patients for HG have a significantly shorter length of stay. There is no predictive value in the reviewed serum biomarkers as to the likelihood of re-admission.

Keywords: Hyperemesis gravidarum, early pregnancy, ambulatory care, day case, length of stay, serum biomarker.

[1]
Gadsby R, Barnie-Adshead AM, Jagger C. A prospective study of nausea and voiting during pregnancy. Br J Gen Pract 1993; 43: 245-8.
[2]
Lacroix R, Eason E, Melzack R. Nausea and vomiting during pregnancy: A prospective study of its frequency, intensity, and patterns of change. Am J Obstet Gynecol 2000; 182: 931-7.
[3]
Verberg MFG, Gillott DJ, Al-Fardan N, Grudzinskas JG. Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005; 11: 527-39.
[4]
Piwko C, Koren G, Babashov V, Vicente C, Einarson TR. Economic burden of nausea and vomiting of pregnancy in the USA. J Popul Ther Clin Pharmacol 2013; 20: e149-60.
[5]
Mazzotta P, Maltepe C, Navioz Y, Magee LA, Koren G. Attitudes, management and consequences of nausea and vomiting of pregnancy in the United States and Canada. Int J Gynaecol Obstet 2000; 70: 359-65.
[6]
Festin M. Nausea and vomiting in early pregnancy. BMJ Clin Evid 2014; 2014: 1405.
[7]
Lagiou P. Nausea and vomiting in pregnancy in relation to prolactin, estrogens, and progesterone: A prospective study. Obstet Gynecol 2003; 101: 639-44.
[8]
Fairweather DV. Nausea and vomiting in pregnancy. Am J Obstet Gynecol 1968; 102: 135-75.
[9]
Thorp JM, Watson WJ, Katz VL. Effect of corpus luteum position on hyperemesis gravidarum. A case report. J Reprod Med 1991; 36: 761-2.
[10]
Dökmeci F, Engin-Ustün Y, Ustün Y, Kavas GO, Kocatürk PA. Trace element status in plasma and erythrocytes in hyperemesis gravidarum. J Reprod Med 2004; 49: 200-4.
[11]
Panesar NS, Li CY, Rogers MS. Are thyroid hormones or hCG responsible for hyperemesis gravidarum? A matched paired study in pregnant Chinese women. Acta Obstet Gynecol Scand 2001; 80: 519-24.
[12]
Jacoby EB, Porter KB. Helicobacter pylori infection and persistent hyperemesis gravidarum. Am J Perinatol 1999; 16(2): 85-8.
[13]
Kuşcu NK, Koyuncu F. Hyperemesis gravidarum: Current concepts and management. Postgrad Med J 2002; 78: 76-9.
[14]
Bacak SJ, Callaghan WM, Dietz PM, Crouse C. Pregnancy-associated hospitalizations in the United States, 1999-2000. Am J Obstet Gynecol 2005; 192: 592-7.
[15]
Einarson TR, Piwko C, Koren G. Quantifying the global rates of nausea and vomiting of pregnancy: A meta analysis. J Popul Ther Clin Pharmacol 2013; 20: e171-83.
[16]
Naef RW, Chauhan SP, Roach H, Roberts WE, Travis KH, Morrison JC. Treatment for hyperemesis gravidarum in the home: An alternative to hospitalization. J Perinatol 1995; 15: 289-92.
[17]
Alalade AO, Khan R, Dawlatly B. Day-case management of hyperemesis gravidarum: Feasibility and clinical efficacy. J Obstet Gynaecol 2007; 27: 363-4.
[18]
González N, Quintana JM, Bilbao A, et al. Development and validation of an in-patient satisfaction questionnaire. Int J Qual Health Care 2005; 17(6): 465-72.
[19]
Nguyen TD, Attkisson CC, Stegner BL. Assessment of patient satisfaction: Development and refinement of a service evaluation questionnaire. Eval Program Plann 1983; 6: 299-313.
[20]
De Brey H. A cross-national validation of the client satisfaction questionnaire: The Dutch experience. Eval Program Plann 1983; 6: 395-400.
[21]
McCarthy FP, Murphy A, Khashan AS, et al. Day care compared with inpatient management of nausea and vomiting of pregnancy: A randomized controlled trial. Obstet Gynecol 2014; 124: 743-8.
[22]
Appleby J. Day case surgery: A good news story for the NHS. BMJ 2015; 351: h4060.
[23]
Burns LR, Wholey DR. the effects of patient, hospital, and physician characteristics on length of stay and mortality. Med Care 1991; 29: 251-71.
[24]
Xavier A. Hospital competition, GP fundholders and waiting times in the UK internal market: The case of elective surgery. Int J Health Care Finance Econ 2003; 3: 25-51.
[25]
Koren G, Boskovic R, Hard M, Maltepe C, Navioz Y, Einarson A. Motherisk-PUQE (pregnancy-unique quantification of emesis and nausea) scoring system for nausea and vomiting of pregnancy. Am J Obstet Gynecol 2002; 186(Suppl. 5): S228-31.


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 15
ISSUE: 2
Year: 2019
Page: [130 - 136]
Pages: 7
DOI: 10.2174/1573404814666180329151025
Price: $58

Article Metrics

PDF: 23
HTML: 2