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An outcomes evaluation of an emergency department early pregnancy assessment service and early pregnancy assessment protocol
  1. Kim Wendt1,2,3,
  2. Julia Crilly4,5,6,
  3. Chris May1,7,
  4. Kym Bates1,
  5. Rakhee Saxena1
  1. 1Department of Emergency Medicine, Redland Hospital, Cleveland, Queensland, Australia
  2. 2Capricorn Coast Hospital and Health Services, Yeppoon, Queensland, Australia
  3. 3State Wide and CQ NP Network, Queensland, Australia
  4. 4Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
  5. 5Clinical Access and Redesign Unit, Brisbane, Queensland, Australia
  6. 6Centre for Health Practice Innovation, Griffith University, Gold Coast, Queensland, Australia
  7. 7School of Medicine, University of Queensland, Brisbane, Queensland, Australia
  1. Correspondence to Kim Wendt, Emergency Department, Capricorn Coast Hospital and Health Services, Hoskyn Drive, Yeppoon, QLD, 4073, Australia; kim_wendt{at}health.qld.gov.au

Abstract

Background Complications in early pregnancy, such as threatened or actual miscarriage is a common occurrence resulting in many women presenting to the emergency department (ED). Early pregnancy service delivery models described in the literature vary in terms of approach, setting and outcomes. Our objective was to determine outcomes of women who presented to an Australian regional ED with diagnoses consistent with early pregnancy complications following the implementation of an early pregnancy assessment service (EPAS) and early pregnancy assessment protocol (EPAP) in July 2011.

Methods A descriptive, comparative (6 months before and after) study was undertaken. Data were extracted from the hospital ED information system and medical healthcare records. Outcome measures included: time to see a clinician, ED length of stay, admission rate, re-presentation rate, hospital admission and types of pathology tests ordered.

Results Over the 12 -month period, 584 ED presentations were made to the ED with complications of early pregnancy (268 PRE and 316 POST EPAS–EPAP). Outcomes that improved statistically and clinically following implementation included: time to see a clinician (decreased by 6 min from 35 to 29 min), admission rate (decreased 6% from 14.5% to 8.5%), increase in β-human chorionic gonadotrophin ordering by 10% (up to 80% POST), increase in ultrasound (USS) performed by 10% (up to 73% POST) and increase in pain score documentation by 23% (up to 36% POST).

Conclusions The results indicate that patient and service delivery improvements can be achieved following the implementation of targeted service delivery models such as EPAS and EPAP in the ED.

  • emergency care systems, admission avoidance
  • emergency care systems, emergency departments
  • obstetrics and gynaecology

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

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