Nuffield Department of Primary Care Health Science, Oxford, UK.
Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
BMC Health Serv Res. 2020 Jul 17;20(1):664. doi: 10.1186/s12913-020-05524-8.
In the UK Early Pregnancy Assessment Units (EPAUs) are usually situated alongside hospital maternity and gynaecology services. In June 2018, the Oxford EPAU relocated from the John Radcliffe Hospital to a community clinic. This is to our knowledge, the UK's first community-based EPAU. This change was inspired by our patient feedback describing the co-location of the EPAU with maternity services as distressing.
Following the introduction of the community EPAU we developed a database to capture information on the patients seen in the clinic. This is a retrospective observational study of a single cohort of patients attending the clinic over an 8 month period. Data was collected from 1st July 2018 to 28th February 2019. This data included clinical, safety and patient experience outcomes.
Two thousand nine hundred and twenty patient episodes were recorded, 1,932 were new patients. Mean waiting time to be seen in clinic was 1.3 days. When miscarriage was confirmed 48.6% chose conservative management, 19.9% chose medical management, and 31.5% chose surgical management. The mean rate of ambulance transfers to hospital was 3.1 per month. Of all patients seen in EPAU 32 had unplanned admissions, which accounted for 2.7% of all patients seen in EPAU. Patient feedback questionnaires have been consistently positive.
The development of a community EPAU has improved services to allow care closer to home in an environment separate from maternity care. Our data shows that a community EPAU can deliver timely, good quality patient care, is safe, and a service valued by patients. Further research is indicated to evaluate the cost-effectiveness of community EPAUs and the long term safety and effectiveness of care.
在英国，早期妊娠评估单位（EPAUs）通常与医院产科和妇科服务毗邻。2018 年 6 月，牛津 EPAU 从约翰拉德克利夫医院迁至社区诊所。据我们所知，这是英国首个社区化的 EPAU。这一变化的灵感来自于我们的患者反馈，他们描述了 EPAU 与产科服务的毗邻位置令人痛苦。
在引入社区 EPAU 后，我们开发了一个数据库来收集诊所就诊患者的信息。这是一项针对在诊所就诊的单一队列患者进行的 8 个月回顾性观察研究。数据收集时间为 2018 年 7 月 1 日至 2019 年 2 月 28 日。该数据包括临床、安全和患者体验结果。
记录了 2920 例患者就诊，其中 1932 例为新患者。在诊所就诊的平均等待时间为 1.3 天。当确认流产时，48.6%的患者选择保守治疗，19.9%的患者选择药物治疗，31.5%的患者选择手术治疗。平均每月有 3.1 例患者被救护车转往医院。在所有 EPAU 就诊的患者中，有 32 例患者计划外入院，占 EPAU 就诊患者的 2.7%。患者反馈问卷一直是积极的。
社区 EPAU 的发展改善了服务，使患者能够在家附近获得护理，且环境与产科护理分开。我们的数据表明，社区 EPAU 能够提供及时、高质量的患者护理，是安全的，并且受到患者的重视。需要进一步研究来评估社区 EPAUs 的成本效益以及护理的长期安全性和有效性。
