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Retrospective Cohort Study on Acute Care in Obstetrics and Gynecology: Analogies and Differences When Compared to Emergency Medicine

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Open Journal of Obstetrics and Gynecology 2017年第4期7卷 473-485页

作者： giuseppe chiossi Stefano Palomba Sara Balduzzi Maged M. Costantine Angela I. Falbo Anna M. Ferrari Giovanni B. La Sala Department of Obstetrics and Gynecology University of Texas Medical Branch Galveston TX USA Department of Obstetrics and Gynecology Arcispedale Santa Maria Nuova IRCCS Reggio Emilia Italy Statistics Unit Department of Oncology Hematology and Respiratory Diseases University of Modena and Reggio Emilia Modena Italy Department of Emergency Medicine Arcispedale Santa Maria Nuova IRCCS Reggio Emilia Italy University of Modena and Reggio Emilia via Università 4 Modena Italy

Introduction: the demand for urgent obstetric and gynecology care has progressively increased: in the United States approximately 1.4 million gynecologic visits are made to the emergency department (ED) annually, while almost 75% of women make at least 1 unscheduled visit during pregnancy. Moreover, research has recently focused on setting standards in unscheduled care, and developing quality indicators to improve patients’ health. Therefore, we investigated the characteristics of women with acute gynecological or pregnancy complaints using quality indicators developed for emergency medicine, to better define the needs of this population and improve care. Methods: Retrospective cohort study on ED, and Obstetrics and Gynecology (ObGyn) triage visits, at a tertiary care hospital in Italy, during 2012. Data were analyzed with population-averaged logistic regression and Poisson regression. Results: When compared to the 33,557 ED visits, the 9245 ObGyntriage referrals were more frequently associated with pregnancy (≤12 weeks’ gestation, OR: 30.7, 95%CI;24.5 - 38.4;>12 weeks’ gestation, OR 81.2, 95%CI;64.8 - 101.4), vaginal bleeding (OR 156.6, 95%CI;82.7 - 294.4), diurnal (night access OR 0.87, 95% CI;0.78 - 0.96) and weekday access (holiday access OR 0.87, 95%CI;0.78 - 0.95), frequent users (recurrent ED visits IRR 0.87, 95%CI;0.83 - 0.9) and lower hospital admissions (ED admission OR 1.6, 95%CI;1.4 - 1.8). Conclusion: ObGyn triage patients differed from ED users, and were at higher risk of “crowding”. Such diversities should be considered to improve female healthcare services and allocate resources more efficiently.

关键词： Acute Care Obstetric Urgencies Gynecologic Urgencies Obstetrics and Gynecology Triage Emergency Department

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