The early pregnancy assessment project: the effect of cooperative care in the emergency department for management of early pregnancy complications.
BACKGROUND
Early pregnancy assessment clinics (EPAC) have been introduced and accepted as the gold standard for management of early pregnancy problems (EPP). However, EPAC are not universally available and management of EPP within the emergency department (ED) can result in prolonged waiting times, inappropriate use of resources and no clear treatment or follow-up plan being implemented.


OBJECTIVE
To assess the effect of an early pregnancy assessment protocol (EPAP) in the ED, designed to create a cultural change among doctors in relation to EPP in order to minimise use of resources, improve treatment times for patients and establish a clear management plan where dedicated EPAC services are not available.


METHODS
An intervention, the EPAP was introduced to the ED and retrospective and prospective audits of the patients were carried out to assess the effect.


RESULTS
Implementation of the EPAP decreased treatment time by 55%, representations by 48%, pathology blood tests by 56% and formal imaging services by 85%. Gynaecological consultation increased by 37% for each patient visit to the ED and by 9% for each EPP. Total direct cost saving was 63% per patient and no adverse outcomes were recorded.


CONCLUSIONS
Introduction of the EPAP was successful in creating cultural change and delivering clinical and financial benefits to the hospital, patients and staff. Early gynaecological consultation and bedside ultrasound scanning within the ED were key factors. Similar benefits could be reproduced in other institutions and for other clinical scenarios where a need has been identified.
O'Rourke
David
D
Department of Obstetrics and Gynaecology, The Canberra Hospital, Woden, Australian Capital Territory, Australia. rourkey@ozemail.com.au
Wood
Stephen
S
D000022:Abortion, Spontaneous / Q000175:diagnosis* / Q000628:therapy; D003266:Continuity of Patient Care; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008485:Medical Audit; D010347:Patient Care Planning; D010865:Pilot Projects; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011271:Pregnancy, Ectopic / Q000175:diagnosis* / Q000628:therapy; D012017:Referral and Consultation; D012189:Retrospective Studies; D014218:Triage; D016216:Ultrasonography, Prenatal