Acute Gynaecology and Early Pregnancy Unit, Nepean Centre for Perinatal Care, Nepean Clinical School, University of Sydney, Nepean Hospital, Penrith, Sydney, Australia.
Ultrasound Obstet Gynecol. 2010 Mar;35(3):344-8. doi: 10.1002/uog.7523.
To assess the impact of the introduction of an ultrasound-based model of care for women with acute gynecological complications.
This was a prospective comparative study of women attending an ultrasound-based acute gynecology unit (AGU) at the Nepean Hospital during a 6-week period 4 months after the unit's inception (new model of care), and a group of women presenting at the hospital during a similar period 6 months immediately prior to the unit's inception (traditional model). In the new model of care, ultrasound was performed at the time of the initial assessment by a senior clinician. The main outcome measures were admission rates and occupied bed days.
The study included 290 consecutive women with complete data, 133 before and 157 after the introduction of the AGU. Compared with the group presenting before establishment of the AGU, the group who attended the AGU had significantly lower admission rate (7% vs. 36%, P < 0.0001) and significantly shorter time to see a trainee gynecologist (mean, 172 vs. 205 min, P = 0.00089), time to ultrasound examination (mean, 199 vs. 533 min, P < 0.0001), length of stay as an outpatient (mean, 45 vs. 248 min, P < 0.0001), fewer occupied bed days (total, 30 vs. 85 days, P < 0.0001) and lower surgical intervention rates (12% vs. 29%, P = 0.00025). They also had significantly higher expectant management rate (26 vs. 8%, P = 0.00023). The extrapolated annual reduction in occupied bed days represented a total financial saving of $ 257 617 Australian dollars.
In the AGU, the availability of ultrasound carried out by a senior clinician with an interest in gynecological emergencies may lead to a reduction in admissions and improved outcomes.
评估为急性妇科并发症女性引入基于超声的护理模式的影响。
这是一项前瞻性比较研究，纳入在超声妇科急症单位（AGU）成立后 4 个月的 6 周内（新模式）和该单位成立前 6 个月的类似时期内就诊于 Nepean 医院的一组女性（传统模式）。在新模式中，高级临床医生在初步评估时进行超声检查。主要结局指标为住院率和占用床位天数。
共纳入 290 例连续完整数据的女性，其中 133 例在 AGU 成立前，157 例在 AGU 成立后。与 AGU 成立前就诊的组相比，AGU 就诊组的住院率显著降低（7% vs. 36%，P<0.0001），并且能够更快地见到妇科住院医师（平均，172 分钟 vs. 205 分钟，P=0.00089），更快地进行超声检查（平均，199 分钟 vs. 533 分钟，P<0.0001），门诊留观时间更短（平均，45 分钟 vs. 248 分钟，P<0.0001），占用床位天数更少（总天数，30 天 vs. 85 天，P<0.0001），手术干预率更低（12% vs. 29%，P=0.00025）。他们也有更高的期待管理率（26% vs. 8%，P=0.00023）。估计每年减少的占用床位天数代表了 257617 澳元的总财务节省。
在 AGU 中，由对妇科急症有兴趣的高级临床医生进行超声检查的可用性可能会降低住院率并改善结局。
