Patel Serena, Thayanithy Niksan
General Surgery, Imperial College NHS Trust, London, GBR.
Emergency Medicine, Ipswich Hospital, Ipswich, GBR.
Cureus. 2024 Sep 21;16(9):e69834. doi: 10.7759/cureus.69834. eCollection 2024 Sep.
Introduction Guidelines state that all female patients of childbearing age presenting with acute abdominal pain to a surgical department must have a pregnancy test with either urinary or serum beta-human chorionic gonadotropin (𝜷-HCG) testing. This allows complete evaluation of the patient and consideration of a wider range of differential diagnoses, including those that must not be missed, such as a possible ectopic pregnancy. Additionally, management options for conditions unrelated to pregnancy may differ in pregnant women. This audit assessed adherence to guidelines for pregnancy testing in females presenting with abdominal pain to the general surgery department in a district general hospital and the impact of initiatives to improve compliance. Methods A retrospective audit to identify pregnancy test completion of all female patients aged between 11 and 55 years presenting to the general surgery department at a district general hospital with acute abdominal pain in August 2022 was conducted. A medical education session, posters, and discussion amongst multidisciplinary team members in a nursing huddle followed to raise awareness. A subsequent prospective audit was conducted in November 2022. Results In the initial audit conducted in August 2022, 55 female patients aged between 11 and 55 years presented to the surgical department with abdominal pain. Of these patients, pregnancy testing was only completed for 41.8% (n = 23). Following interventions, a second audit conducted in November 2022 found 30 female patients presenting with abdominal pain. In this cohort, pregnancy testing was completed for 80% of patients (n = 24). Conclusion This study highlights the need for regular clinical audits and multidisciplinary discussion in improving and maintaining high standards of patient care and ensuring pregnancy testing of all females of reproductive age presenting with abdominal pain to the general surgery department. Further consideration may be given to the incorporation of recording of pregnancy test status on electronic healthcare systems as part of admission and mandatory checklists.
引言 指南规定，所有因急性腹痛到外科就诊的育龄女性患者都必须进行尿液或血清β-人绒毛膜促性腺激素（β-HCG）检测以进行妊娠试验。这有助于对患者进行全面评估，并考虑更广泛的鉴别诊断，包括那些绝不能漏诊的情况，如可能的异位妊娠。此外，与妊娠无关疾病的管理方案在孕妇中可能有所不同。本次审核评估了一家地区综合医院普通外科中因腹痛就诊的女性患者妊娠试验指南的遵守情况以及提高依从性措施的影响。
方法 进行了一项回顾性审核，以确定2022年8月在一家地区综合医院普通外科因急性腹痛就诊的所有11至55岁女性患者的妊娠试验完成情况。随后开展了医学教育课程、张贴海报，并在护理小组中进行多学科团队成员间的讨论以提高认识。2022年11月进行了后续的前瞻性审核。
结果 在2022年8月进行的首次审核中，有55名年龄在11至55岁之间的女性患者因腹痛到外科就诊。在这些患者中，仅41.8%（n = 23）完成了妊娠试验。经过干预后，2022年11月进行的第二次审核发现有30名女性患者因腹痛就诊。在这个队列中，80%的患者（n = 24）完成了妊娠试验。
结论 本研究强调了定期进行临床审核和多学科讨论对于改善和维持高标准患者护理以及确保所有因腹痛到普通外科就诊的育龄女性进行妊娠试验的必要性。可进一步考虑将妊娠试验状态记录纳入电子医疗系统，作为入院和强制检查清单的一部分。
