by Rebecca Brennan


Download the poster for this Quality Improvement


Hyperemesis Gravidarum (HG) affects approximately 1 to 3 in every 100 pregnant women.

In 2017, a day case pathway for patients with HG was implemented. At the time there were up to 70 patients attending the hospital each year in the county.

With COVID-19 the clinic was moved to GOPD. There have been significant increases in patients attending the hospital with HG since the original set up, highlighting the pressures and gaps that remain in this service.

Patients with HG are still having to attend ED when attending out of hours for the clinic. The treatment they receive is not always delivered in a timely manner, or the full treatment. This is due to lack of capacity for the whole county, as well as lack of knowledge.

The treatment required by HG patients hasn’t changed much since 2017, however there has been little evidence to suggest overnight stays are required. By improving the access to treatment, education for healthcare professionals and patients and time management, the care HG patient receive should improve and benefit everyone involved.


To increase patients receiving correct Hyperemesis Gravidarum treatment by 25% within 6 months.


Data has been collected monthly, including the route of referral.

Improved documentation, by creating a proforma with all criteria and treatment plan clearly stated. Including dosages of medications.


September 2022 to January 2023 – increase of 150% attendances for HG treatment.

There is still a significant gap due to the services opening hours, 8 patients attended ED on 16 occasions.

Lessons Learnt

Communication between different healthcare groups, including different hospital departments improves patient care, and outcomes. By ensuring the patient is passed on the treatment information allows optimum care in appropriate settings.

Next steps

At present, ensuring the unit remains as ward based, and is staffed 7 days per week is critical.

Longer term the plan will be to make the unit 24 hours, 7 days per week.

Possibly would benefit from being ANP led, with doctor support when required.