Wendt Kim, Crilly Julia, May Chris, Bates Kym, Saxena Rakhee
Department of Emergency Medicine, Redland Hospital, Cleveland, Queensland, Australia Capricorn Coast Hospital and Health Services, Yeppoon, Queensland, Australia State Wide and CQ NP Network, Queensland, Australia.
Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia Clinical Access and Redesign Unit, Brisbane, Queensland, Australia Centre for Health Practice Innovation, Griffith University, Gold Coast, Queensland, Australia.
Emerg Med J. 2014 Oct;31(e1):e50-4. doi: 10.1136/emermed-2013-202887. Epub 2013 Oct 17.
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.
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.
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).
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.
早期妊娠并发症，如先兆流产或实际流产是常见情况，导致许多女性前往急诊科（ED）就诊。文献中描述的早期妊娠服务提供模式在方法、环境和结果方面各不相同。我们的目的是确定自2011年7月实施早期妊娠评估服务（EPAS）和早期妊娠评估方案（EPAP）后，因早期妊娠并发症诊断而前往澳大利亚地区急诊科就诊的女性的结局。
进行了一项描述性、比较性（实施前后各6个月）研究。数据从医院急诊科信息系统和医疗保健记录中提取。结局指标包括：见到临床医生的时间、急诊科停留时间、入院率、再次就诊率、住院情况以及所开具的病理学检查类型。
在这12个月期间，共有584例因早期妊娠并发症前往急诊科就诊（EPAS - EPAP实施前268例，实施后316例）。实施后在统计学和临床上得到改善的结局包括：见到临床医生的时间（从35分钟减少到29分钟，减少了6分钟）、入院率（从14.5%降至8.5%，降低了6%）、β - 人绒毛膜促性腺激素检测开具量增加了10%（实施后高达80%）、超声检查（USS）实施量增加了10%（实施后高达73%）以及疼痛评分记录增加了23%（实施后高达36%）。
结果表明，在急诊科实施诸如EPAS和EPAP等有针对性的服务提供模式后，可以实现患者和服务提供方面的改善。
