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A prospective study of obstetrical patients from enrollment as outpatients until postpartum discharge was formulated at Madigan Army Medical Center. The control group included uncomplicated obstetrical patients from March 1 to August 31, 1994. The study group included uncomplicated obstetrical patients from March 1 to August 31, 1996. Patient satisfaction, identification of barriers to care, recognition of areas to improve quality of care, and cost-consequence analysis were studied. There were 1,042 control patients totaling 2,668 hospital days, with mean hospital stays of 2.56 days per patient (SD = 0.878). The study cohort comprised 1,050 patients with 1,965 hospital days, with a mean of 1.87 hospital days per patient (SD = 1.48). The study cohort demonstrated a statistically significant decrease (p < 0.05) in admission length of stay in the early discharge vaginal delivery gravidas, with cost savings from $3.2 million to $2.4 million. Using an interdisciplinary approach, we were able to elucidate the process necessary to identify critical nodes of patient care and satisfaction while providing significant cost savings.

Uncomplicated Pregnancy: Clinical Pathway Genesis Based on the Nursing Process