ArticleBMJ open quality2026
Reducing postoperative length of stay in low-risk caesarean section: a system-level quality improvement initiative.
Article in BMJ open quality, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
A structured, system-level quality improvement (QI) initiative at Singapore General Hospital was undertaken to reduce postoperative length of stay (LOS) after uncomplicated lower segment caesarean section (LSCS) and improve performance on the national Value-Driven Care clinical quality index. This project specifically targeted an increase in postoperative day 3 (POD3) discharge rates towards the 88% internal benchmark without compromising safety or increasing readmissions.Uncomplicated LSCS cases between October 2023 and September 2025 were included, with complicated caesarean sections and severe neonatal morbidity excluded. A single-centre pre-post design was used, with October 2023-September 2024 as the baseline period and October 2024-September 2025 as the intervention period. Root causes of delayed discharge were identified using a fishbone (Ishikawa) analysis, informing a three-phase, system-level intervention: department-wide performance sharing, a bundled intervention (standardised patient education, multidisciplinary discharge coordination via Microsoft Teams and coding support) and clinician-specific feedback.Baseline POD3 discharge performance was 80.0% (n=352) after correction of coding inaccuracies. Following phased implementation, the postoperative LOS ≤3 days rate increased to 84.5% (n=241) overall, with a more marked improvement from 83.3% to 92.5% after introduction of the bundled system-level intervention. Run charts showed an upward shift and reduced monthly variation in POD3 discharge rates, indicating more consistent practice. There was no clinically significant increase in 30-day readmissions, emergency attendances or postoperative complications, and a simple cost analysis estimated savings of SGD 70 884 from reduced LOS.This multidisciplinary, enhanced recovery after surgery-aligned QI project successfully shortened postoperative LOS for uncomplicated LSCS without evidence of harm. Core components-clear discharge expectations, coordinated mother-baby discharge planning, accurate coding and non-punitive clinician feedback-are conceptually transferable to similar obstetric units seeking to optimise postcaesarean LOS within value-based care frameworks.
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