Factors affecting length of stay for women presenting with early pregnancy complications to a public hospital emergency department

Objective: This study aimed to determine factors associated with length of stay (LOS) for women presenting with early pregnancy complications to a public hospital ED. In particular, we sought to investigate the impact the involvement of the Clinical Midwife Consultant (CMC), specialising in early pregnancy care, had on the ED LOS.

Methods: We undertook a retrospective cohort study of women less than 20 weeks pregnant who presented between August 2008 and December 2010 with early pregnancy complications to the ED of the Royal Prince Alfred Hospital in Sydney, Australia and who were then discharged. The main outcome measured was LOS. We performed logistic regression analysis to identify factors significantly associated with this outcome.

Results: Data were available for 1739 women. Involvement of the CMC reduced LOS and patients were significantly more likely to be discharged within 4 h or less (OR = 0.47, 95% CI = 0.37-0.60). The factors that increased LOS to over 4 h were arrival after hours (OR = 2.09, 95% CI = 1.66-2.63), being triaged as category 1 to 3 (OR = 1.36, 95% CI = 1.11-1.67) and requiring an ultrasound assessment (OR = 2.44, 95% CI = 1.81-3.28).

Conclusions: This study was able to show factors significantly associated with ED LOS, many of which are not modifiable. The involvement of the CMC reduced LOS, whereas requiring an ultrasound assessment increased LOS. Thus, improvement could be achieved by greater access to a CMC and more rapid access to ultrasound services.