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Services for emergency department patients experiencing early pregnancy complications: A survey of Ontario hospitals

  • Robin Glicksman (a1), Shelley L McLeod (a1) (a2) (a3), Jackie Thomas (a3) (a4) and Catherine Varner (a1) (a2) (a3)

Abstract

Objectives

Women experiencing complications of early pregnancy frequently seek care in the emergency department (ED), because most have not yet established care with an obstetrical provider. The primary objective of this study was to explore the services available (ED management, ultrasound access, and follow-up care) for ED patients experiencing early pregnancy loss or threatened early pregnancy loss in Ontario hospitals.

Methods

The emergency medicine chiefs of 71 Ontario hospital EDs with an annual census of more than 30,000 ED patient visits in 2017 were invited to complete a 30-item, online questionnaire using modified Dillman methodology.

Results

Respondents from 63 EDs across Ontario completed the survey (response rate 88.7%). Of the EDs surveyed, 34 (54.0%) reported that they did not have access to early pregnancy clinic services for women who presented to the ED with early pregnancy complications that were safe to discharge home. At these hospitals, it was found that patients were followed up in 14 (41.2%) EDs for the same complications, including pregnancy of unknown location and threatened abortion. Respondents also stated that a radiologist-interpreted ultrasound was available to only 22 (34.9%) of hospital sites for 24 hours, 7 days per week for women with early pregnancy complications.

Conclusions

The results of this study highlight the reliance of some hospitals on the ED to provide ongoing follow-up care to patients experiencing complications of early pregnancy. The lack of clinical resources and specialized personnel in Ontario hospital EDs makes supporting these women longitudinally unrealistic, exposing them to undue risk and complications.

Objectif

Les femmes qui présentent des complications en début de grossesse consultent souvent au service des urgences (SU), la plupart d'entre elles n'ayant pas encore de plan de soins déjà établi par un professionnel de la santé en obstétrique. L’étude avait pour objectif principal de relever les services (prise en charge au SU, échographie, suivi) auxquels les femmes ayant fait un avortement spontané ou étant en état de menace d'avortement en début de grossesse avaient accès au SU, dans les hôpitaux, en Ontario.

Méthode

Les chefs des services de médecine d'urgence de 71 hôpitaux, en Ontario, ayant reçu plus de 30 000 patients en 2017 ont été invités à répondre à un questionnaire en ligne, composé de 30 éléments et envoyé selon une version modifiée de la méthode de Dillman.

Résultats

Les chefs de 63 SU, de partout en Ontario, ont rempli le questionnaire (taux de réponse : 88,7%). Sur ce nombre, 34 (54,0%) ont indiqué ne pas pouvoir offrir des services cliniques de début de grossesse aux femmes consultant au SU pour des complications gravidiques précoces, et jugées en état de retourner à domicile. D'après l'enquête, les femmes étaient suivies pour ces mêmes complications, notamment des grossesses de siège inconnu ou des menaces d'avortement, dans 14 SU (41,2%) de ces hôpitaux. De plus, les femmes connaissant des complications en début de grossesse ne pouvaient profiter de services d'interprétation d’échographies par des radiologistes, 24 heures sur 24, 7 jours sur 7, que dans 22 des hôpitaux participants (34,9%).

Conclusion

Les résultats de l’étude font ressortir la confiance que mettent certains hôpitaux dans les SU pour offrir un suivi continu aux femmes souffrant de complications en début de grossesse. Le manque de ressources cliniques et de personnel spécialisé dans les SU, en Ontario, rend irréaliste le suivi longitudinal de ces femmes et, de ce fait, les expose à des risques indus et à des complications.

Copyright

Corresponding author

Correspondence to: Dr. Catherine Varner, Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Department of Family and Community Medicine, University of Toronto, 206-600 University Avenue, Toronto, ON M5G 1X5; Email: catherine.varner@sinaihealthsystem.ca

References

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Canadian Journal of Emergency Medicine
  • ISSN: -
  • EISSN: 1481-8035
  • URL: /core/journals/canadian-journal-of-emergency-medicine
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