ELECTIVIST: a novel system to improve elective caesarean section booking.

Area of Science:

• Obstetrics and Gynecology
• Surgical Management
• Healthcare Systems Optimization

Background:

• Elective caesarean sections (ELCS) exhibit significant variability in surgical complexity.
• Current unselected ELCS lists pose clinical risks due to complex case mixes and theatre time overruns, impacting emergency obstetric services.
• Effective booking systems for ELCS are lacking despite widespread concerns about list overruns.

Purpose of the Study:

• To design and evaluate a novel risk scoring system, ELECTIVIST, for optimizing elective caesarean section (ELCS) booking.
• To assess the impact of the ELECTIVIST system on theatre list overruns and resource utilization in obstetric units.

Main Methods:

• Development of the ELECTIVIST risk scoring system, assigning complexity scores (1-6) based on clinician assessment.
• Retrospective analysis of 2016 ELCS data to evaluate existing case mix complexity and theatre overruns.
• Post-implementation assessment of ELECTIVIST's impact on theatre overruns, emergency care, and ELCS capacity requirements.

Main Results:

• Prior to ELECTIVIST, 36% of ELCS lists were overbooked with complex cases, and 21% overran, with 6% affecting emergency theatres.
• Following ELECTIVIST implementation, theatre overruns decreased to 10%, and overruns impacting emergency theatres reduced to 1%.
• The need for additional ELCS lists decreased by 66% after implementing the ELECTIVIST system.

Conclusions:

• The ELECTIVIST system effectively improves elective caesarean section booking by managing case complexity within existing capacity.
• Implementation of ELECTIVIST significantly reduces theatre list overruns and minimizes impact on emergency obstetric services.
• ELECTIVIST is a transferable, cost-neutral solution with potential for wide application in obstetric units.