Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, United Kingdom.
Department of Statistical Science, University College London, London, United Kingdom.
PLoS One. 2021 Nov 30;16(11):e0260534. doi: 10.1371/journal.pone.0260534. eCollection 2021.
To determine whether the participation of consultant gynaecologists in delivering early pregnancy care results in a lower rate of acute hospital admissions.
Prospective cohort study and emergency hospital care audit; data were collected as part of the national prospective mixed-methods VESPA study on the "Variations in the organization of EPAUs in the UK and their effects on clinical, Service and PAtient-centred outcomes".
44 Early Pregnancy Assessment Units (EPAUs) across the UK randomly selected in balanced numbers from eight pre-defined mutually exclusive strata.
6606 pregnant women (≥16 years old) with suspected first trimester pregnancy complications attending the participating EPAUs or Emergency Departments (ED) from December 2016 to July 2017.
Planned and actual senior clinician presence, unit size, and weekend opening.
Unplanned admissions to hospital following any visit for investigations or treatment for first trimester complications as a proportion of women attending EPAUs.
205/6397 (3.2%; 95% CI 2.8-3.7) women were admitted following their EPAU attendance. The admission rate among 44 units ranged from 0% to 13.7% (median 2.8). Neither planned senior clinician presence (p = 0.874) nor unit volume (p = 0.247) were associated with lower admission rates from EPAU, whilst EPAU opening over the weekend resulted in lower admission rates (p = 0.027). 1445/5464 (26.4%; 95%CI 25.3 to 27.6) women were admitted from ED. There was little evidence of an association with planned senior clinician time (p = 0.280) or unit volume (p = 0.647). Keeping an EPAU open over the weekend for an additional hour was associated with 2.4% (95% CI 0.1% to 4.7%) lower odds of an emergency admission from ED.
Involvement of senior clinicians in delivering early pregnancy care has no significant impact on emergency hospital admissions for early pregnancy complications. Weekend opening, however, may be an effective way of reducing emergency admissions from ED.
确定顾问妇科医生参与提供早孕保健是否会降低急性住院率。
前瞻性队列研究和急诊医院护理审计；数据是作为英国“早期妊娠评估单位（EPAU）组织变化及其对临床、服务和以患者为中心的结果的影响”的全国前瞻性混合方法 VESPA 研究的一部分收集的。
在英国，从八个预先定义的相互排斥的层中以平衡的数量随机选择了 44 个早孕评估单位（EPAU）。
2016 年 12 月至 2017 年 7 月期间，6606 名（≥16 岁）疑似早孕并发症的孕妇在参加 EPAU 或急诊部（ED）就诊。
计划和实际高级临床医生的存在、单位规模和周末开放。
在因早孕并发症接受任何检查或治疗后，因任何原因前往 EPAU 就诊的女性中，计划外住院的比例。
205/6397（3.2%；95%CI 2.8-3.7）名妇女在 EPAU 就诊后住院。44 个单位的住院率范围为 0%至 13.7%（中位数 2.8%）。计划中的高级临床医生的存在（p = 0.874）或单位数量（p = 0.247）均与 EPAU 的较低入院率无关，而 EPAU 周末开放则导致较低的入院率（p = 0.027）。1445/5464（26.4%；95%CI 25.3 至 27.6）名妇女从 ED 住院。几乎没有证据表明计划中的高级临床医生时间（p = 0.280）或单位数量（p = 0.647）与入院率有关。将 EPAU 周末额外开放一小时与从 ED 紧急入院的可能性降低 2.4%（95%CI 0.1%至 4.7%）相关。
高级临床医生参与提供早孕保健对早孕并发症的急诊住院治疗没有显著影响。然而，周末开放可能是减少从 ED 紧急入院的有效方法。
