Implementation of an Outpatient Cervical Ripening Initiative: Outcomes and Patient and Provider Perspectives.
Objective: 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. Study Design: Initially, outpatient cervical ripening was "availa...
| Publicado en: | American Journal of Perinatology Vol. 43; no. 9; pp. 1204 - 1213 |
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| Autores principales: | , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Thieme Medical Publishing Inc.
Jul2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=194646034&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 194646034 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 07351631 GQK jtl: American Journal of Perinatology issn: 07351631 maglogo: N pubinfo: dt: Jul2026 vid: 43 iid: 9 pid: 2811 pub: Thieme Medical Publishing Inc. place: New York, New York artinfo: ui: 194646034 194646034 194646034 10.1055/a-2729-1329 194646034 ppf: 1204 ppct: 9 formats: tig: atl: Implementation of an Outpatient Cervical Ripening Initiative: Outcomes and Patient and Provider Perspectives. aug: au: Zhu, Katherine H. Gilani, Sonia Suresh, Sunitha C. Adams, Marci Hirsch, Emmet affil: Department of Obstetrics & Gynecology, University of Chicago Medical Center, Chicago, Illinois, United States sug: subj: Cervix Dilatation and Effacement Labor, Induced Equipment and Supplies Outpatient Service Pregnancy Outcomes Length of Stay Delivery Rooms Patient Attitudes Attitude of Health Personnel Program Implementation Implementation Science Human Pregnancy Female Outpatients Misoprostol Administration and Dosage Administration, Intravaginal Inpatients Delivery, Obstetric Chorioamnionitis Postpartum Hemorrhage Intensive Care Units, Neonatal Infant, Hospitalized Comparative Studies Job Satisfaction Workflow Comfort Quality Improvement Program Evaluation Descriptive Statistics Expectant Mothers Psychosocial Factors Personnel, Health Facility Psychosocial Factors Chi Square Test T-Tests Data Analysis Software Adult Adult: 19-44 years Female ab: Objective: 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. Study Design: 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. Results: 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. Conclusion: 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. Key Points: 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. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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