title: Gynecologists in the VA: do they enhance availability of sex-specific services and policies in the emergency department?
abstract: OBJECTIVE
  To examine the association between on-site gynecology and availability of sex-specific services and policies in Department of Veterans Affairs (VA) emergency departments (EDs).
  
  
  METHODS
  Cross-sectional analysis using data from a VA national inventory of emergency services for women and gynecologist staffing information from the VA Office of Productivity, Efficiency, and Staffing.
  
  
  METHODS
  ED directors from all VA medical centers (N=120).
  
  
  METHODS
  We used logistic regression to evaluate the association between on-site gynecologist full-time equivalents (FTEs, <0.5 and ≥0.5), and availability of sex-specific ED services, such as consult and follow-up within VA by a gynecologist, emergency contraception, rho (D) immunoglobulin, pelvic ultrasound, and transfer policies for obstetric and gynecologic emergencies. All analyses were adjusted for number of ED encounters by women.
  
  
  RESULTS
  Greater gynecologist FTE (≥0.5 vs. <0.5) was associated with increased odds of on-site availability of a gynecology consultation in the ED [odds ratio (OR)=10.9; 95% confidence interval (CI): 3.2, 36.6] and gynecologist follow-up within VA after an ED encounter (OR=2.5; 95% CI: 1.0, 6.2). A positive trend was seen in availability of rho (D) immunoglobulin (OR=1.4; 95% CI: 0.6, 3.5) and presence of transfer policies for obstetric (OR=1.7; 95% CI: 0.7, 4.5) and gynecologic emergencies (OR=1.6; 95% CI: 0.6, 4.2). Half of the facilities with <0.5 FTE did not have transfer policies in place or under development.
  
  
  CONCLUSIONS
  On-site gynecologist FTE is associated with improved availability of sex-specific care in EDs. Development of transfer processes for obstetric and gynecologic emergencies in settings with limited on-site gynecology is needed.
authors.affiliation: *Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System †Department of Health Services, University of Washington School of Public Health, Seattle, WA ‡Office of Patient Care, Office of Women's Health Services, Department of Veteran's Affairs, Washington, DC §Department of Epidemiology, University of Washington School of Public Health ∥Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA ¶Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, Department of Veterans Affairs Greater Los Angeles Healthcare System #Los Angeles School of Medicine, University of California, Los Angeles **RAND Corporation, Santa Monica, CA ††Department of Veterans Affairs New York Harbor Healthcare System ‡‡New York University Langone Medical School, New York, NY.
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Gray
authors.forename: Jodie G
authors.initials: JG
authors.lastname: Katon
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Callegari
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Cordasco
authors.forename: Laurie C
authors.initials: LC
authors.lastname: Zephyrin
mesh_terms: D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D005831:Genital Diseases, Female / Q000628:therapy*; D006176:Gynecology; D006297:Health Services Accessibility; D006787:Hospitals, Veterans; D006801:Humans; D016134:Organizational Policy; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health; D016387:Women's Health; D000078329:Workforce