received in an early pregnancy assessment unit: an interpretive phenomenological analysis Wendy Norton, Lynn Furber To cite: Norton W, Furber L. An exploration of how women in the UK perceive the provision of care received in an early pregnancy assessment unit: an interpretive phenomenological analysis. J Ultrasound Med 2018;37:15338. Accessed 14 Feb 2019. First choice of management of miscarriage was most commonly conservative management 48.6%, followed by 31.5% choosing surgical management and 19.9% choosing medical management. EPAUs were developed to offer better care to women and reduce admissions to gynaecology wards, and are usually located within obstetric and gynaecology departments facilitating communication with acute gynaecology care. Following clinic attendance 72.2% (n=1045) of patients were diagnosed with a viable intrauterine pregnancy. - we'll pass your stories to the people in health and social care who can make a difference. Early Pregnancy Assessment Unit (EPAU) | Hull University Teaching doi: 10.1371/journal.pone.0260534. The Early Pregnancy Assessment Service (EPAS) is a clinic for women experiencing vaginal bleeding and / or lower abdominal pain under 20 weeks of pregnancy. Visit https://www.careopinion.org.uk GPs made 20.3% of referrals, the hospital gynaecology ward referred 7.5%, and A&E made 3.8% of referrals. The intercom is not in a suitable position to allow wheelchair users to gain access. Cookies policy. I have never been so pleased to get out of a ward, I was concerned that should my Father stay any longer he may come to further harm, I am sure this was not the intention but it was the feeling I was left with. Using a holistic approach women will receive support, advice and care individualised to their own specific needs. During the eight months of data collection 25 ambulance transfers were made from the clinic to the John Radcliffe hospital, four of these were for patients who had no transport themselves, and the remaining patients were all due to medical emergency such as being haemodynamically unstable, bleeding, pain, faint, or ruptured ectopic. The typical cost of an ambulance transfer is approximately 250. In June 2018, the Oxford EPAU relocated from the John Radcliffe Hospital to a community clinic. Thank you for the comments regarding your fathers care on the Assessment Suite at the Royal Victoria Infirmary, We are very disappointed to hear that you had concerns about the care provided, and are grateful to you for bringing these to our attention. This may be due, in part, to health care professional preference to send these patients to the ED owing to concern for possible ectopic pregnancy and may create a bias to triage patients perceived as more acute to the ED over the early pregnancy unit. 3. Emergency admissions to hospital from EPAU made up only 1.8% of patients seen in the community EPAU. There is a small lip on the threshold of the entrance, with a height of 2cm or below. Conclusion: In the community clinic quality of care rated excellent increased from 60 to 89%, emotional support rated excellent improved from 50 to 74.7%, and overall experience rated excellent improved from 57.5 to 81.7%. The .gov means its official. Vespa study. To monitor the first 6 months of the EPAU service in the Rotunda Hospital, to identify its shortcomings, so that we can ensure effective EPAU care in future. Visit https://www.careopinion.org.uk My early scans have all been through GP referral so you could try talking to your GP. Additionally, we performed a basic analysis of total charges for each visit as a surrogate for cost. Referrals were classified into self, GP, A&E, and gynaecology ward referrals. Br Med J 1991;302:5779. From the group of ectopic pregnancies managed conservatively or medically, 6 went on to have surgical treatment, a rate of 31.6%. 7 years ago. Patients in the early pregnancy unit were identified by a registry within the electronic medical record that tracks all patients seen in the early pregnancy unit. unexplained abdominal pain or bleeding. About: The early pregnancy assessment unit (EPAU) provides care, treatment and support for those women who experience bleeding in pregnancy prior to 12 weeks. Ugeskr Laeger 1999;161:15861. Correspondence to Cox, R., Khalid, S., Brierly, G. et al. Exploring the services and management available to women experiencing complications in early pregnancy: a survey of Ontario, Canada hospitals. Federal government websites often end in .gov or .mil. Department of Obstetrics & Gynecology, University of Colorado School of Medicine, Aurora, and Denver Health Medical Center, Denver, Colorado. There is a large variation in the way EPAU services run across the UK, with differences in levels of care, accessibility and staffing. The mean rate of transfers per month was 3.1 (range 010). Some cookies are essential for you to be able to experience the full functionality of our site. The Assessment Suite has 50 beds and has around 64 emergency admissions each day, which means that the nursing and medical teams are understandably very busy throughout the day due to the activity on the unit and the dependency of the patients requiring assessment and treatment. Detailed information, also Wolters Kluwer Health In light of your feedback, all staff have been reminded of the importance of communication and provision of timely information and of the need to involve the patient, relative or carer in any decisions made regarding the patients management. The commonest initial presentation to EPAU was with bleeding 43.5%, with pain 19.8%, both bleeding and pain 22.5, and 14.2% for other reasons such as previous ectopic pregnancy. We care for those in very early pregnancy. The https:// ensures that you are connecting to the Unplanned admission of patients seen in the community EPAU was collected for the months December 2018April 2019. Following my third loss I was referred into the RMC service, tests showed there was no cause found, and I have been treat with care and compassion ever since. Seven patients were transferred for heavy bleeding or collapse with a diagnosis of miscarriage or PUL. Water bowls for assistance dogs are available. The name / number of the room surveyed was; Counselling Room. I It is difficult to compare unplanned admission rates between centres, as there will be differences in populations, protocols, and services provided; however our study shows that our unplanned admission rates are better. They could be: The students can be at various stages of their training and may be male or female. RM: project development for EPAU, design of study and planning. From the miscarriage group 84.1% were missed or incomplete miscarriages, 15.9% were complete miscarriages. Three of these patients had a negative laparoscopy. It is your decision as to whether you will allow any student to participate or watch any or all of your babys care or whether you would like to decline students altogether. If you have unfortunately experienced a pregnancy loss, you can Six patients were transferred because a ruptured ectopic pregnancy was diagnosed on ultrasound. Given competing demands and varying levels of acuity in the ED, patients often experience prolonged waiting times. We also collected 40 surveys from the hospital based EPAU clinic prior to moving location. Tell us what was good and what could be improved, say thanks or call for change Elective referrals for surgical management are not included in this data. 4. Background: 1993 Apr 3;306(6882):894-5 Visit website. The maximum total charges between groups was also noticeably different ($2,125.91 for the early pregnancy unit vs $23,995.62 for the ED). Two of these patients went on to have surgical management- one of which was a suspected ectopic and operated on out of hours. This could include anonymous information of how you got to the site, the pages you visit and how long you spend on each page. The Early Pregnancy Assessment Unit is/are located on level 4 of the Leazes Wing. their pregnancy or labour. The name / number of the room surveyed was; Ultrasound Room. During the 8month period a total of 113 patients were referred into hospital. No hospital staff receive deaf awareness training. 2013. Kong GW, Lok IH, Yiu AK, Hui AS, Lai BP, Chung TK. MeSH NG126 miscarriage and ectopic pregnancy. National Institute of Clinical Excellence. official website and that any information you provide is encrypted For our current job vacancies, please visit the careers section. The entrance area/door is not clearly signed. Lastly, as a way to estimate cost, all professional and facility charges were obtained for each visit. PMC Patient information, including demographics, reproductive histories, presenting symptoms, discharge diagnosis, and management plans, were extracted from the electronic medical record, as were times of registration and discharge. Springer Nature. PMC Prospective patient feedback data was collected in surveys given to patients from this period. A Novel early pregnancy assessment unit/Gynaecology assessment unit The car parking facilities are for Blue Badge holders only. The waiting room / area does not have background music playing. The development of electronic patient records means that clinical notes can be accessed in the community or within the hospital setting, should they be required, to allow seamless patient care. The Royal Victoria Infirmary 7 years ago. Part of Privacy Patients were seen on the same day for urgent referrals, and the longest wait times were 2weeks to comply with clinic protocols for some patients requiring repeat scans. For hospital details please visit the relevant location. Analytical cookies are used to understand how visitors interact with the website. document.write(new Date().getFullYear()), LHSC, London Ontario Canada, Local clinician scientist receives significant funding to make clinical trials more efficient, Kayley Perfetto receives Patient Experience Scholar Award. to maintaining your privacy and will not share your personal information without One patient had a negative laparoscopy (3.7%). There is/are 4 designated Blue Badge parking bay(s) within the hospital car park. Implementing a community model of early pregnancy care, https://doi.org/10.1186/s12913-020-05524-8, https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/vespa-study/, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/, bmchealthservicesresearch@biomedcentral.com. Seventeen of these patients were managed conservatively (BHCG<1000), of those five went on to have surgical management of non-ruptured ectopic pregnancies (Fig. There is a/are clearly marked/signposted Blue Badge parking bay(s) available. NICE. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Management of women referred to early pregnancy assessment unit: care and cost effectiveness. This category only includes cookies that ensures basic functionalities and security features of the website. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The average waiting time to be seen in clinic was 1.3days, reflecting patients being seen in a timely manner. Being seen in the early pregnancy unit was still independently associated with reduced time to discharge in the adjusted model (P<.001). Other sources contributed 9.6% of referrals, which were from midwives, antenatal radiology clinic, and from local termination and fertility services. Peer reviews and author correspondence are available at https://links.lww.com/AOG/C43. Memtsa M, Goodhart V, Ambler G, Brocklehurst P, Keeney E, Silverio SA, Anastasiou Z, Round J, Khan N, Hall J, Barrett G, Bender-Atik R, Stephenson J, Jurkovic D. PLoS One. But opting out of some of these cookies may affect your browsing experience. Article Early Pregnancy Assessment Unit (EPAU) is a dedicated service that provides quick and easy accessibility to diagnosis, treatment and support service. This Clinic is offered every Monday, Wednesday and Friday. We are disappointed to note that the curtains appeared stained and would wish to assure you that there is a regular programme for changing the curtains. National Library of Medicine Eight patients were transferred due to ectopic or suspected ectopic diagnosis. 1). These account for 2.7% of all patients seen in EPAU during this time period. Early pregnancy assessment unit. Patient Demographic and Clinical Characteristics by Care Setting, Linear Modeling Results of Total Evaluation Time by Care Setting. The highest figure of ten was found in July 2018, the first month of the community clinic, then falls to a steady state between one and four per month (Fig. eCollection 2021. Also of note, early pregnancy units are staffed by obstetrics and gynecology physicians who are arguably more experienced in managing pregnancy concerns and complications than ED physicians, which likely influences the time of evaluation in this setting. There is not a space for a wheelchair user to wait within the seating area. The low number of transfers per month reflects the appropriate triage of the nursing team upon referral, patients with significant pain, heavy bleeding would be triaged to secondary care. We identified many patients seen in the ED who would have been candidates for early pregnancy unit evaluation. The NHS 5 year forward view advocates care closer to home, which this clinic aims to provide. 2. your express consent. An exploration of how women in the UK perceive the provision of care received in an early pregnancy assessment unit: an interpretive phenomenological analysis. In the total sample, median evaluation time was significantly reduced in the early pregnancy unit compared with the ED (45 minutes [interquartile range 3161] vs 236 minutes [interquartile range 173307], respectively, P<.001). Ante natal and maternity have been wonderful too, I have every faith in the staff to continue to look after us. The data was collected during the first 8months of the clinic opening, hence may not represent the performance of the clinic if more time had lapsed to allow the clinic to settle into day to day running. This relocation was made possible by technological advances and developing a highly trained specialist core nursing team.