Hughton Bryden, Roberts Lauren, Bourgeois Zoey, Trivedi Sachin
Department of Emergency Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada.
College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
CJEM. 2025 Jul 14. doi: 10.1007/s43678-025-00958-7.
Early Pregnancy Assessment Clinics provide gold-standard care to patients experiencing complications of early pregnancy, but their impact on emergency department (ED) volumes and consultation practices are largely unknown. The primary objective was to assess the volume of patients experiencing complications of early pregnancy presenting to the ED before and after the opening of an Early Pregnancy Assessment Clinic in Saskatoon, Saskatchewan. Secondary outcomes included inpatient prescribing practices and evaluation of Early Pregnancy Assessment Clinic referral patterns.
We performed a health records review including all patients presenting to 3 Saskatoon-area EDs in the 6 months before and after the Early Pregnancy Assessment Clinic opening and examined all referrals to the center in the first 6 months of its opening. Charts were excluded if patients were directly presenting for a specialist service, were admitted, and were presenting with complications unrelated to fetal outcomes. We calculated descriptive statistics and compared using z tests.
We identified 1242 charts, of which 757 met eligibility criteria. There were 393 visits pre-opening and 364 visits post-opening. However, only 33% of eligible patients were referred to the Early Pregnancy Assessment Clinic in the 6-month period after it was opened. Direct referrals to obstetrics decreased 39.9% from 20.1% to 12.1% (p = 0.002).
While patient visits were only moderately reduced and return visits were the same in the pre- and post- opening periods, the number of inpatient consults to obstetrics and gynecology were significantly reduced. This is clinically important in reducing the burden of in-hospital consults and allowing for greater flow through the ED while providing patient-centered care.
早期妊娠评估诊所为出现早期妊娠并发症的患者提供金标准护理，但其对急诊科（ED）就诊量和会诊模式的影响在很大程度上尚不清楚。主要目的是评估在萨斯喀彻温省萨斯卡通市开设早期妊娠评估诊所前后，前往急诊科就诊的出现早期妊娠并发症患者的数量。次要结果包括住院处方实践以及对早期妊娠评估诊所转诊模式的评估。
我们进行了一项健康记录审查，纳入了早期妊娠评估诊所开业前后6个月内前往萨斯卡通地区3家急诊科就诊的所有患者，并检查了该诊所在开业后前6个月内的所有转诊情况。如果患者直接前往专科服务就诊、已住院或出现与胎儿结局无关的并发症，则排除其病历。我们计算了描述性统计数据并使用z检验进行比较。
我们识别出1242份病历，其中757份符合纳入标准。开业前有393次就诊，开业后有364次就诊。然而，在早期妊娠评估诊所开业后的6个月内，只有33%的符合条件的患者被转诊至该诊所。直接转诊至产科的比例从20.1%降至12.1%，下降了39.9%（p = 0.002）。
虽然开业前后患者就诊量仅适度减少且复诊量相同，但妇产科的住院会诊次数显著减少。这在减轻院内会诊负担、使急诊科流量更大以及提供以患者为中心的护理方面具有重要临床意义。
