VA Health Services Research & Development (HSR&D) Center of Excellence for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (111G), Los Angeles, CA 90073, USA.
J Gen Intern Med. 2013 Jul;28 Suppl 2(Suppl 2):S583-90. doi: 10.1007/s11606-012-2327-7.
More women are using Veterans' Health Administration (VHA) Emergency Departments (EDs), yet VHA ED capacities to meet the needs of women are unknown.
We assessed VHA ED resources and processes for conditions specific to, or more common in, women Veterans.
DESIGN/SUBJECTS: Cross-sectional questionnaire of the census of VHA ED directors
Resources and processes in place for gynecologic, obstetric, sexual assault and mental health care, as well as patient privacy features, stratified by ED characteristics.
All 120 VHA EDs completed the questionnaire. Approximately nine out of ten EDs reported having gynecologic examination tables within their EDs, 24/7 access to specula, and Gonorrhea/Chlamydia DNA probes. All EDs reported 24/7 access to pregnancy testing. Fewer than two-fifths of EDs reported having radiologist review of pelvic ultrasound images available 24/7; one-third reported having emergent consultations from gynecologists available 24/7. Written transfer policies specific to gynecologic and obstetric emergencies were reported as available in fewer than half of EDs. Most EDs reported having emergency contraception 24/7; however, only approximately half reported having Rho(D) Immunoglobulin available 24/7. Templated triage notes and standing orders relevant to gynecologic conditions were reported as uncommon. Consistent with VHA policy, most EDs reported obtaining care for victims of sexual assault by transferring them to another institution. Most EDs reported having some access to private medical and mental health rooms. Resources and processes were found to be more available in EDs with more encounters by women, more ED staffed beds, and that were located in more complex facilities in metropolitan areas.
Although most VHA EDs have resources and processes needed for delivering emergency care to women Veterans, some gaps exist. Studies in non-VA EDs are required for comparison. Creative solutions are needed to ensure that women presenting to VHA EDs receive efficient, timely, and consistently high-quality care.
越来越多的女性开始使用退伍军人健康管理局（VHA）的急诊部（ED），但 VHA ED 满足女性需求的能力尚不清楚。
我们评估了 VHA ED 针对女性退伍军人特有的或更常见的疾病的资源和流程。
设计/主体：对 VHA ED 主任进行的横断面问卷调查
根据 ED 特征，评估妇科、产科、性侵犯和心理健康护理的资源和流程，以及患者隐私特征。
120 家 VHA ED 完成了问卷调查。大约十分之九的 ED 报告称其 ED 内有妇科检查台，可 24/7 使用窥器和淋病/衣原体 DNA 探针。所有 ED 都报告称 24/7 可进行妊娠检测。不到五分之二的 ED 报告称其 24/7 可获得放射科医生对盆腔超声图像的审查；三分之一的 ED 报告称 24/7 可获得妇科医生的紧急咨询。不到一半的 ED 报告称有专门针对妇科和产科急症的书面转院政策。大多数 ED 报告称可 24/7 提供紧急避孕药；但只有大约一半的 ED 报告称可 24/7 提供 Rho(D)免疫球蛋白。报告称很少有 ED 提供与妇科疾病相关的模板分诊记录和标准医嘱。与 VHA 政策一致，大多数 ED 报告称通过将性侵犯受害者转移到其他机构来为他们提供护理。大多数 ED 报告称有一些私人医疗和心理健康室可供使用。资源和流程在女性就诊次数更多、ED 配备床位更多且位于大都市地区更复杂设施的 ED 中更为可用。
尽管大多数 VHA ED 都有为女性退伍军人提供急诊护理所需的资源和流程，但仍存在一些差距。需要对非 VA ED 进行研究以作比较。需要创造性地解决问题，以确保到 VHA ED 就诊的女性获得高效、及时和始终高质量的护理。
