Real-world implementation of a vaginal preparation policy prior to cesarean delivery.

OBJECTIVE: Surgical site infections (SSIs) are a major source of morbidity and mortality for women who undergo cesarean section (c-section). SSIs following c-section include wound infection, infection of the endometrium (endometritis) and intra-abdominal infections. Perioperative interventions to prevent these infections continue to be studied, including the use of vaginal preparation prior to c-section. Although literature has shown that the use of vaginal preparation prior to c-section decreases the rate of SSI, real-world clinical data regarding effective implementation of these policies are lacking. The objectives of this study were to determine (1) if a vaginal preparation policy could be implemented in a real-world setting with a high compliance rate and (2) to identify factors led to differences in compliance with policy. STUDY DESIGN: This was a secondary analysis of a retrospective cohort study designed to examine the incidence of SSI after c-section before and after the implementation of vaginal preparation policy. The primary outcomes included implementation rates of the vaginal preparation for the post policy cohort. Secondary outcomes included subgroup analysis of policy adherence based on time of day, urgency of delivery, membrane status, labor status, and maternal factors. RESULTS: Overall adherence to the vaginal preparation policy was 87.2% of patients. Maternal factors did not impact the rate of policy adherence. 81.4% of patients undergoing c-section at night had vaginal prep completed compared to 89.9% of patients undergoing c-section during the day (p = .016). 63.8% of patients undergoing emergent c-section had vaginal prep completed, compared to 90.1% of patients undergoing non-emergent c-section (p < .001). Laboring patients were more likely to have vaginal preparation completed (143 (95.3%) vs. 225 (82.7%), p = .009). CONCLUSIONS: Compliance with vaginal preparation policy was high. Patients who are undergoing evening deliveries and emergent deliveries are less likely to have vaginal preparation completed. Some of these differences are likely attributable to perceived urgency of the c-section. It is important that interventions are identified such as staff education and standardization of documentation to improve rates of policy adherence.

Secure messaging and diabetes management: experiences and perspectives of patient portal users.

BACKGROUND: Patient portal use has been associated with favorable outcomes, but we know less about how patients use and benefit from specific patient portal features. OBJECTIVE: Using mixed-methods, we explored how adults with type 2 diabetes (T2DM) use and benefit from secure messaging (SM) within a patient portal. METHODS: Adults with T2DM who had used a patient portal participated in a focus group and completed a survey (n=39) or completed a survey only (n=15). We performed thematic analysis of focus group transcripts to identify the benefits of and barriers to using SM within a portal. We also examined the association between use of various patient portal features and patients' glycemic control. RESULTS: Participants were on average 57.1 years old; 65% were female; 76% were Caucasian/White, and 20% were African American/Black. Self-reported benefits of SM within a portal included enhanced patient satisfaction, enhanced efficiency and quality of face-to-face visits, and access to clinical care outside traditional face-to-face visits. Self-reported barriers to using SM within a portal included preconceived beliefs or rules about SM and prior negative experiences with SM. Participants' assumptions about providers' opinions about SM and providers' instructions about SM also influenced use. Greater self-reported use of SM to manage a medical appointment was significantly associated with patients' glycemic control (ρ=-0.29, p=0.04). CONCLUSION: SM within a portal may facilitate access to care, enhance the quality of office visits, and be associated with patient satisfaction and clinical outcomes for patients with diabetes, but provider communication about SM is essential.