Standardization of Evaluation and Management of Early Pregnancy Concerns in the Emergency Department: A Quality Improvement Initiative ID 2683509

INTRODUCTION: This study explored the effect of a standardized protocol for gynecologic consultation on readmissions for early pregnancy concerns in the emergency department (ED). METHODS: We conducted a retrospective cohort study of pregnant patients presenting to the ED for first trimester pregnancy concerns from January 2020 to March 2023. In October 2022, ED protocols were standardized such that gynecology was consulted for all pregnant patients without intrauterine pregnancy and cardiac motion. Patients seen before implementation (January 2020 to June 2021) were compared to patients seen after (October 2022 to March 2023). Chi-squared test and Fisher's exact test were used to investigate the association between readmission and reason for readmission to intervention period. The primary outcome, preventable readmission rate, was defined as a readmission that could have been prevented if the patient received correct counseling, diagnosis, or management at the index admission. This protocol was approved for IRB exemption by the University of Texas at Austin Dell Medical School. RESULTS: We identified 383 patients in the pre-implementation cohort compared to 130 patients seen after. There was an increase in the rate of gynecologic consultation for all concerns (30% before versus 40% after; P =.06). Fewer readmissions occurred after implementation (31% before versus 26% after) and preventable readmission decreased significantly (28% before versus 0% after; P <.001). Documented counseling about diagnosis also increased (74% versus 96%; P <.001) post-implementation. CONCLUSION: Readmission to the ED is common in early pregnancy; standardization of gynecologic consultation for early pregnancy care in the ED can improve quality of care and reduce readmissions.