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Delays to Surgery in Emergency Department Cases of Ectopic Pregnancy: A Quality Improvement Study

Published:November 24, 2022DOI:https://doi.org/10.1016/j.jogc.2022.11.004

      Abstract

      Objective

      Create a process map for emergency department (ED) presentations of surgical ectopic pregnancy, and identify areas of management amenable to quality improvement.

      Methods

      A retrospective chart review of all patients undergoing surgical management of ectopic pregnancy at a large, urban, academic tertiary care centre from 2015 to 2017 was performed.

      Results

      Seventy-three patients were included. There were 6 (8.2%) unstable A cases (recommended time to operating room [OR] 0–2 hours), 23 (31.5%) stable A cases, and 44 (60%) B cases (recommended time to OR 2–8 hours). The percent of patients who were in the OR within the recommended time window were 6 (100%) for unstable A cases, 13 (56%) stable A cases, and 29 (65.9%) stable B cases, respectively (P = 0.139). Notable time delays include the time from gynaecology referral to the time seen by gynaecology (29.7% of total wait time for stable A cases from ED to OR) and the time the OR was booked to the time the patient was brought to the OR (53.2% of total wait time for stable B cases). Of the patients seen by physician at the emergency department first, the time from triage to the OR was significantly shorter for patients that received bedside ultrasound only (0.67 ± 0.5 hours vs. 2.1 ± 1.8 hours [P = 0.007]).

      Conclusion

      This is the first study to map the ED presentation of surgical ectopic pregnancy. The management of ectopic pregnancy would benefit from the development of surgical triage decision aids, a surgical care pathway, and increased use of screening bedside ultrasound.

      Résumé

      Objectif

      Dresser le parcours de prise en charge chirurgicale de la grossesse ectopique au service d’urgence, et déterminer les secteurs de prise en charge où la qualité pourrait être améliorée.

      Méthodologie

      Un examen rétrospectif a été effectué pour les dossiers de toutes les patientes ayant subi une prise en charge chirurgicale d’une grossesse ectopique dans un grand centre de soins tertiaires urbain pendant la période de 2015 à 2017.

      Résultats

      Soixante-quinze patientes ont été incluses. De ce nombre, on compte 6 cas A instables (8,2 %) (délai urgence-chirurgie recommandé de 0–2 h), 23 cas A stables (31,5 %) et 44 cas B (60 %) (délai urgence-chirurgie recommandé de 2–8 h). Le nombre de patientes s’étant retrouvées en salle d’opération dans les délais recommandés était de 6 (100 %) pour les cas A instables, de 13 (56 %) pour les cas A stables et de 29 (65,9 %) pour les cas B stables, respectivement (p = 0,139). On observe un temps d’attente notable entre la demande de consultation en gynécologie et le moment où la patiente est vue par un gynécologue (29,7 % du délai urgence-chirurgie pour les cas A stables) et entre le moment d’attribution du temps opératoire et l’arrivée de la patiente en salle d’opération (53,2 % du délai total pour les cas B stables). Des patientes vues par un médecin à l’urgence d’abord, le délai triage-chirurgie était significativement plus court pour celles ayant eu une échographie au chevet seulement (0,67 ± 0,5 h p/r à 2,1 ± 1,8 h [p = 0,007]).

      Conclusion

      Il s’agit de la première étude qui dresse le parcours de prise en charge de la grossesse ectopique au service d’urgence. Il serait bénéfique, pour la prise en charge de la grossesse ectopique, d’élaborer des outils d’aide au triage chirurgical, d’établir un parcours de prise en charge chirurgicale et d’augmenter l’utilisation de l’échographie au chevet.

      Keywords

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