Trostian Baylie, McCloughen Andrea, Curtis Kate
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Emergency Department, Wollongong Hospital, Wollongong, New South Wales, Australia.
Emerg Med Australas. 2025 Feb;37(1):e14507. doi: 10.1111/1742-6723.14507. Epub 2024 Oct 7.
To determine the proportion of women presenting to EDs across a regional health district, with early pregnancy bleeding, who received appropriate care.
Retrospective cohort review of linked data from five data sets: ED, pathology, radiology, costs and non-admitted/outpatient. Data collected from five EDs between January 2011 and December 2020, across one health district in NSW, Australia, with 150 000 annual ED presentations. Management received by women of reproductive age, with early pregnancy (<20 weeks gestation) bleeding was compared to seven indicators for recommended care. Indicators included blood tests, psychosocial support, administration of Rhesus D immunoglobulin and US. Indicators were determined by a systematic analysis of published primary research, expert consensus clinical practice guidelines and literature reviews on initial assessment, intervention and diagnostics for women with early pregnancy bleeding.
There was no evidence of almost one third of women (n = 3661, 29.4%) receiving any indicators and 54 (0.4%) received five or more indicators of appropriate care. Presentations to rural facility had the lowest number and proportion of indicators being performed (n = 603, 58.0% for no indicators). Cost increased with the number of indicators. Over the study period, the proportion of all indicators being performed increased, and indicator six - psychosocial support referral or care had the biggest growth (almost 500%).
Variation in care for women presenting with early pregnancy bleeding to ED was identified. There is an evidence-practice gap and need for inquiry into barriers and facilitators to prescribed clinical practice for this population.
确定在一个区域卫生区的急诊科就诊的早期妊娠出血女性中接受适当护理的比例。
对来自五个数据集（急诊科、病理学、放射学、费用及非住院/门诊）的关联数据进行回顾性队列研究。数据收集于2011年1月至2020年12月期间，来自澳大利亚新南威尔士州一个卫生区的五家急诊科，每年急诊科就诊量为150000人次。将育龄期早期妊娠（妊娠<20周）出血女性所接受的管理与推荐护理的七个指标进行比较。指标包括血液检查、心理社会支持、注射RhD免疫球蛋白和超声检查。这些指标是通过对已发表的原始研究、专家共识临床实践指南以及关于早期妊娠出血女性初始评估、干预和诊断的文献综述进行系统分析确定的。
几乎三分之一的女性（n = 3661，29.4%）未接受任何指标的护理，54名（0.4%）女性接受了五项或更多适当护理指标。在农村医疗机构就诊的患者接受指标检查的数量和比例最低（无指标的为n = 603，58.0%）。费用随指标数量增加。在研究期间，所有指标的执行比例有所增加，指标六——心理社会支持转诊或护理的增长幅度最大（近500%）。
确定了早期妊娠出血女性在急诊科接受护理存在差异。存在证据与实践的差距，需要探究该人群规定临床实践的障碍和促进因素。
