title: An outcomes evaluation of an emergency department early pregnancy assessment service and early pregnancy assessment protocol.
abstract: BACKGROUND
  Complications in early pregnancy, such as threatened or actual miscarriage is a common occurrence resulting in many women presenting to the emergency department (ED). Early pregnancy service delivery models described in the literature vary in terms of approach, setting and outcomes. Our objective was to determine outcomes of women who presented to an Australian regional ED with diagnoses consistent with early pregnancy complications following the implementation of an early pregnancy assessment service (EPAS) and early pregnancy assessment protocol (EPAP) in July 2011.
  
  
  METHODS
  A descriptive, comparative (6 months before and after) study was undertaken. Data were extracted from the hospital ED information system and medical healthcare records. Outcome measures included: time to see a clinician, ED length of stay, admission rate, re-presentation rate, hospital admission and types of pathology tests ordered.
  
  
  RESULTS
  Over the 12 -month period, 584 ED presentations were made to the ED with complications of early pregnancy (268 PRE and 316 POST EPAS-EPAP). Outcomes that improved statistically and clinically following implementation included: time to see a clinician (decreased by 6 min from 35 to 29 min), admission rate (decreased 6% from 14.5% to 8.5%), increase in β-human chorionic gonadotrophin ordering by 10% (up to 80% POST), increase in ultrasound (USS) performed by 10% (up to 73% POST) and increase in pain score documentation by 23% (up to 36% POST).
  
  
  CONCLUSIONS
  The results indicate that patient and service delivery improvements can be achieved following the implementation of targeted service delivery models such as EPAS and EPAP in the ED.
authors.affiliation: Department of Emergency Medicine, Redland Hospital, Cleveland, Queensland, Australia Capricorn Coast Hospital and Health Services, Yeppoon, Queensland, Australia State Wide and CQ NP Network, Queensland, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Wendt
authors.affiliation: Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia Clinical Access and Redesign Unit, Brisbane, Queensland, Australia Centre for Health Practice Innovation, Griffith University, Gold Coast, Queensland, Australia.
authors.forename: Julia
authors.initials: J
authors.lastname: Crilly
authors.affiliation: Department of Emergency Medicine, Redland Hospital, Cleveland, Queensland, Australia School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: May
authors.affiliation: Department of Emergency Medicine, Redland Hospital, Cleveland, Queensland, Australia.
authors.forename: Kym
authors.initials: K
authors.lastname: Bates
authors.affiliation: Department of Emergency Medicine, Redland Hospital, Cleveland, Queensland, Australia.
authors.forename: Rakhee
authors.initials: R
authors.lastname: Saxena
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D002985:Clinical Protocols; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008427:Maternal Health Services; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000628:therapy*; D011261:Pregnancy Trimester, First; D012189:Retrospective Studies; D061665:Time-to-Treatment; D055815:Young Adult
keywords: emergency care systems, admission avoidance; emergency care systems, emergency departments; obstetrics and gynaecology