Date of Award
Winter 2025
Project Type
Clinical Doctorate
College or School
CHHS
Department
Nursing
Program or Major
Nursing
Degree Name
Other
First Advisor
Dr.Catherine Colleran
Abstract
Background: Cervical ripening is a critical component of labor induction. Outpatient cervical ripening using mechanical dilators offers a safe patient- centered alternative to inpatient management, with potential benefits in efficiency and patient satisfaction and cost savings.
Local Problem: At a community hospital setting with increasing induction rates, prolonged admission-to-delivery times and prolonged patient stays were observed in patients undergoing inpatient cervical ripening, prompting a need for more efficient, patient centered approaches.
Methods: Using the Plan-Do-Study-Act (PDSA) framework, an outpatient cervical ripening protocol was implemented over a 15-week period to compare inpatient versus outpatient cervical ripening using mechanical dilators. A standardized procedure and policy were developed, along with staff and patient education. Outcome measures included admission-to- delivery times, average length of stay (LOS), fetal and maternal safety along with patient satisfaction.
Intervention: Of 52 patient who received cervical ripening, 17 met criteria for outpatient management, and 4 received outpatient care. The inpatient group (n=13) had an average LOS of 76 hours and admission-to-delivery time of 28 hours. The outpatient group (n=4) had an average LOS of 82 hours and admission-to-delivery time of 33 hours.
Results: Of the 52 patients receiving cervical ripening, 17 met edibility criteria for outpatient care and 4 participated. Vaginal delivery rates were comparable between the outpatient (75%) and inpatient (68.8%) groups with no maternal of fetal complications. The outpatient group had a slightly longer admission-to-delivery time (33.5 vs. 28 hours, p=0.30) and LOS (82.3 vs. 76.4 hours, p= 0.006) though results were not clinically significant.
Conclusion: Outpatient cervical ripening was successfully implemented in the community hospital setting supporting patient autonomy and maintaining maternal and fetal safety. Further expansion and study are needed to help to confirm cost savings, improve the patient experience and contribute to achieving the national goals for reducing low-risk cesarean delivery rates.
Recommended Citation
St Hilaire, April, "Implementation of Outpatient Cervical Ripening in the Community Hospital Setting: A Quality Improvement Process" (2025). DNP Scholarly Projects. 136.
https://scholars.unh.edu/scholarly_projects/136