Implementation of an Outpatient Cervical Ripening Initiative: Outcomes and Patient and Provider Perspectives

This study aimed to examine implementation and patient/provider acceptance of an outpatient mechanical cervical ripening program for labor induction with the goal of reducing length of stay in labor and delivery (L&D) unit.

Initially, outpatient cervical ripening was "available," and later (due to low utilization) "mandatory" for eligible patients who were induced Monday through Friday, with weekend induction available for those declining outpatient ripening. Single-balloon catheters were used, with supplemental vaginal misoprostol for inpatients. Utilization was compared for two 3-month periods (pre- and post-mandatory phases). Patient and provider surveys queried perceived benefits, risks, barriers, pain, likelihood to recommend, and satisfaction. Outcomes (length of stay in L&D, delivery mode, chorioamnionitis, hemorrhage, and NICU admission) were compared between the inpatient and outpatient groups.

Outpatient ripening among eligible patients increased from 13.5 to 55.1% after becoming mandatory (p < 0.01), with 71.4% of patients undergoing either outpatient ripening or induction over the weekend. Staff satisfaction was high, with 91.7% "somewhat" to "very likely" to recommend outpatient ripening. Perceived benefits included decreased time in L&D. Barriers included office workflow and provider comfort with placement. Patient satisfaction and pain scores did not differ by balloon placement location. Among patients eligible for outpatient ripening (n = 224), there was no difference in length of stay in L&D (22.1 hours outpatient versus 24.2 inpatient, p = 0.19). However, among all patients undergoing mechanical ripening (n = 397, a measure of the initiative's impact on L&D congestion), outpatient ripening length of stay was shorter by 4 hours (22.1 versus 26.1 hours, p = 0.01). Delivery outcomes were similar between groups.

Outpatient cervical ripening utilization was minimal until it became mandatory. Providers were overall satisfied. Balloon placement location did not affect patient satisfaction. Among patients undergoing mechanical ripening, those receiving an outpatient balloon had a 4-hour decreased L&D length of stay. There were no differences in delivery outcomes.

· We studied adoption of outpatient cervical ripening.. · A mandatory program was required for adoption.. · Staff were satisfied with the program.. · Ripening location did not affect patient satisfaction.. · L&D time decreased without affecting outcomes..