A Protocol to Evaluate Low Risk Pregnancies of Unknown Location Reduces Emergency Department Length of Stay [17H

Abstract

INTRODUCTION: Women are frequently diagnosed with pregnancy of unknown location (PUL) in the emergency department (ED). These patients often receive a gynecology consult and then must be followed closely to finalize diagnosis. In 2017, our hospital implemented a protocol allowing low-risk patients diagnosed with PUL in the ED to have a telephone consult with gynecology rather than in-person evaluation. We investigated impact of this protocol on ED length of stay (LOS) for these patients. METHODS: Retrospective chart review of patients entered into the beta book from January 2017 to November 2017. All patients entered into the beta book after an ED visit were included, while those diagnosed outpatient were excluded. Primary outcome was ED LOS; secondary outcomes included provider adherence to the protocol and patients' completeness of follow up. RESULTS: 120 subjects were included. LOS was significantly shorter in the telephone consult group (Median 270 min, IQR 223-346 min) than in the standard consult group (Median 345 min, IQR 276-434 min), P=.009. In-person gynecology consult was more likely when: a resident provided the initial evaluation (P=.017), patients presented with pain or nausea (P=.006), and ultrasound demonstrated free fluid (P=.007), adnexal mass (P=.001), or ectopic pregnancy (P<.001). Patient compliance with follow-up care was similar in both groups, and no adverse events were noted during study time frame. CONCLUSION: Patients with PUL not required to have an in-person gynecology consult have a significantly decreased ED LOS without compromising adherence to outpatient care. Such protocols may be safely adopted in tertiary care centers.