Early Pregnancy Loss Management in the Emergency Department vs Outpatient Setting
Lyndsey S. BensonSarah K. HoltJohn L. GoreLisa S. CallegariAnne K. ChipmanLarry G. KesslerVanessa K. Dalton
17
Citation
33
Reference
10
Related Paper
Citation Trend
Abstract:
Importance Early pregnancy loss (EPL), or miscarriage, is the most common complication of early pregnancy, and many patients experiencing EPL present to the emergency department (ED). Little is known about how patients who present to the ED with EPL differ from those who present to outpatient clinics and how their management and outcomes differ. Objective To compare the management and outcomes of patients with EPL who present to the ED vs outpatient clinics. Design, Setting, and Participants This retrospective cohort study used the IBM MarketScan Research Database, a national insurance claims database. Participants were pregnant people aged 15 to 49 years in the US who presented to either an ED or outpatient clinic for initial diagnosis of EPL from October 2015 through December 2019. Data analysis was performed from May 2021 to March 2022. Exposures The primary exposure was location of service (ED vs outpatient clinic). Other exposures of interest included demographic characteristics, current pregnancy history, and comorbidities. Main Outcomes and Measures The primary outcome was EPL management type (surgical, medication, or expectant management). Complications, including blood transfusion and hospitalization, and characteristics associated with location of service were also evaluated. Bivariable analyses and multivariable logistic regression were used for data analysis. Results A total of 117 749 patients with EPL diagnoses were identified, with a mean (SD) age of 31.8 (6.1) years. Of these patients, 20 826 (17.7%) initially presented to the ED, and 96 923 (82.3%) presented to outpatient clinics. Compared with the outpatient setting, patients in the ED were less likely to receive surgical (2925 patients [14.0%] vs 23 588 patients [24.3%]) or medication (1116 patients [5.4%] vs 10 878 patients [11.2%]) management. In the adjusted analysis, characteristics associated with decreased odds of active (surgical or medication) vs expectant management included ED (vs outpatient) presentation (adjusted odds ratio [aOR], 0.46; 95% CI, 0.44-0.47), urban location (aOR, 0.87; 95% CI, 0.82-0.91), and being a dependent on an insurance policy (vs primary policy holder) (aOR, 0.71; 95% CI, 0.67-0.74); whereas older age (aOR per 1-year increase 1.01; 95% CI, 1.01-1.01), established prenatal care (aOR, 2.35; 95% CI, 2.29-2.42), and medical comorbidities (aOR, 1.05; 95% CI, 1.02-1.09) were associated with increased odds of receiving active management. Patients in the ED were more likely than those in outpatient clinics to need a blood transfusion (287 patients [1.4%] vs 202 patients [0.2%]) or hospitalization (463 patients [2.2%] vs 472 patients [0.5%]), but complications were low regardless of location of service. Conclusions and Relevance In this cohort study of privately insured patients with EPL, differences in management between the ED vs outpatient setting may reflect barriers to accessing comprehensive EPL management options. More research is needed to understand these significant differences in management approaches by practice setting, and to what extent EPL management reflects patient preferences in both outpatient and ED settings.Keywords:
Outpatient clinic
Early Pregnancy Loss
Cite
Citations (0)
Cocaine use
Cite
Citations (25)
Cite
Citations (8)
Triage
Cite
Citations (54)
Accident and emergency
Police department
Cite
Citations (0)
Objectives:To describe the rate of complaints from the parents of the children in outpatient department and emergency department,complaint categories,departments involved,outcomes of complaints.Methods:Retro- spective study was conducted to analyze the complaints made by parents of the children in outpatient department and emergency department in Shanghai Children's Medical Center from Jan.2005 to Nov.2007.The main indexes were complaints rate,department involved,complaints and outcomes.Results:The average rate of complaints was 0.133/1000 patients.Complaints relating to treatment,communication,patient' s right and access to healthcare accounted for 37.4%,29.8%,11.6% and 9.9% respectively.Apologies or explanations and educating the health- care staff resolved 73% of complaints.Conclusion:To take complaint data as quality improvement activities is rec- ommended.Interventions to decrease the number of complaints will be educating the healthcare staffs in the areas of communication,establishing reasonable procedure in outpatient department and emergency department.
Complaint
Outpatient clinic
Health department
Cite
Citations (0)
Polyembolokoilamania in the Emergency Department Polyembolokoilamania is a rare but serious medical condition that involves the presence of multiple foreign bodies in the patient's body [1]. This condition can be challenging to diagnose and manage in the emergency department. In this chapter, we will discuss the presentation, diagnosis, and management of polyembolokoilamania in the emergency department.
Presentation (obstetrics)
Cite
Citations (0)
Objective: To assess whether prolonged length of stay in the emergency department was associated with risk of death. Methods: We analysed data from 165,183 arrivals at St. Olav’s University Hospital’s emergency department from 2011 to 2018, using an instrumental variable method. As instruments for prolonged length of emergency department stay, we used indicators measured before arrival of the patient. These indicators were used to study the association between prolonged length of emergency department stay and risk of death, being discharged from the emergency department and length of hospitalisation for those who were hospitalised. Results: Mean length of stay in the emergency department was 2.9 hours, and 30-day risk of death was 3.4%. Per hour prolonged length of stay in the emergency department, the overall change in risk of death was close to zero, with a narrow 95% confidence interval of −0.5 to 0.7 percentage points. Prolonged emergency department stay was associated with a higher probability of being discharged from the emergency department without admission to the hospital. We found no substantial differences in length of hospitalisation for patients who were admitted. Conclusion: In this study, prolonged emergency department stay was not associated with increased risk of death.
Cite
Citations (8)
Emergency Department overcrowding with admitted inpatients is a common international occurrence. We undertook a retrospective review to compare patient admission rates from patients presenting to our Emergency Department with the level of overcrowding with admitted inpatients on that particular day in the Emergency Department. Over the 2-year study period there was no change in the rate or absolute number of admissions per day compared with the level of inpatient overcrowding.
Overcrowding
Cite
Citations (3)
Acute care
Cite
Citations (10)