Title : Quality improvement project: Reducing the length of time women with early pregnancy complications, leading to possible pregnancy loss spend in the emergency department at Sheffield Teaching Hospitals (STH), UK
Abstract:
Background: Prolonged waiting times in the Emergency Department have a significant psychological impact on women experiencing early pregnancy complications and possible pregnancy loss. Sheffield Teaching Hospitals operates across split sites, with the Obstetrics & Gynaecology department at a separate site to ED. This, amongst other factors, creates a barrier to a timely Gynaecology review.
Aim: Reduction in time spent in ED for women presenting with early pregnancy complications.
Methods: QIP involving 4 PDSA cycles - 4 interventions implemented with data analysis of various waiting times after each intervention. Interventions include:
- Introduction of urine test pots at initial booking
- Updated Trust intranet ED guidelines
- Introduction of an ED ‘Gynae equipment grab bag’
- Introduction of direct access to EPAU appointments via online booking systems
Results: Average waiting times across several domains were successfully reduced for this patient cohort.
Conclusions and learning points:
We highlight the importance of understanding the psychological impact on women with early pregnancy complications, who are experiencing long wait times in ED until specialist review. Providing urine sample pots at first point of contact to attain a urinary pregnancy test early, and introducing a ‘gynae grab bag’ to enable quick access to relevant equipment, improves departmental efficiency. Guideline updates provide staff with clear instructions on how to manage this cohort of patients, which reduces need for discussions and in turn, also increases efficiency. Despite the challenge of working across split sites, our introduction of direct access to EPAU appointments via online booking systems have reduced the additional steps of telephone discussions with our Gynae colleagues. We demonstrate a number of achievable changes that can be implemented across other Emergency Departments, that result in more efficient management and reduction in waiting times. Whilst this will be a traumatic time for the patients involved, effective management and reduced waiting times ensure as medical professionals, we alleviate where possible some of the distress on women presenting with early pregnancy complications and possible pregnancy loss.
