Generating evidence to improve care for women with early pregnancy bleeding in the emergency department: A multi-method inquiry

Abstract

Background: Early pregnancy (first 20 weeks) can involve complications such as bleeding, often leading women to present to the emergency department (ED).

Aims: To identify characteristics, trends, care variations, and outcomes; and to generate evidence to improve the care of women with early pregnancy bleeding (EPB) in the ED.

Methods: A multi-method study was conducted: 1) An integrative literature review to identify evidence gaps; 2) A 10-year retrospective cohort study using a linked dataset to determine characteristics, trends, and ED care; 3) A scoping review to consolidate evidence for management of EPB in EDs, and inform a guideline and quality of care indicators; 4) an audit of ED care using the linked dataset from initial cohort study and care indicators; 5) Survey to all ED nurses and doctors to identify care influences for women with EPB; 6) integration of quantitative and qualitative results from all studies to gain new insights and address the thesis aim.

Results: The integrative literature review of 42 articles identified four categories. Cohort study showed that over 10000 women presented almost 15000 times with EPB to an ED in the health district. There were 7 quality of care indicators extracted from the 128 (of 3688) papers included in the scoping review. These were examined against care received by the 10000+ women in the linked dataset, and for about one-third of women there was no evidence of recommended care. From 104 clinicians that completed the survey (21.8% response rate), identified barriers included: knowledge gaps, ED resources, and limitations to available guideline. Final integration of the findings identified 3 requirements for improved ED management of EPB: multimodal education, clinical champions and an updated practice guideline.

Conclusions: Implementing the practice guideline generated in this study, and using multimodal interventions that incorporate behaviour change theory, could improve the quality of care in the ED.