BackgroundWomen present to the emergency department (ED) with pregnancy complications including bleeding. They seek investigations, treatment and clear discharge and referral pathways.AimsThe aim was to identify trends, characteristics, ED care and discharge pathways for women who present to the ED with early pregnancy bleeding.MethodsRetrospective data (from 2011 to 2020) were extracted from a regional health district‘s databank. Data were processed, and deterministic linking was used to produce a final data set. Descriptive statistics were used to identify trends and characteristics. Linear and logistic regression models were used to identify factors that influence health service use, outcomes and discharge pathways.ResultsOver the 10 years, there have been almost 15 000 presentations to the ED for early pregnancy bleeding, from approximately 10 000 women, 0.97% of all ED presentations. The frequency of presentations increased by 19.6% over the study period. The average age of women who presented to the ED was 29.1 years, which increased from 28.5 years (2011) to 29.3 (2020). The median length of stay was less than 4 h, and most women were treated and discharged from the ED. One‐third of presentations received neither ultrasound nor pathology, but health service costs increased by 330% from 2014 to 2020.ConclusionsMaternal age is increasing, as is the frequency of ED presentations for early pregnancy bleeding, and both factors increase demands on the ED. Findings from this study may inform strategies to improve current care models and improve quality and safety practices within the ED.
Background
The routine collection, production and storage of patient data is increasing globally, however the healthcare industry is failing to maximise its use to audit healthcare delivery and inform policy. Linking data allows researchers to generate new insights while protecting patient privacy. Processes of data management and linking can poses challenges for researchers and there is a need for transparent description of methods and solutions. This paper outlines methods used to produce high quality, linked data describing patient health service use and care pathways after presenting to the Emergency Department (ED) with early pregnancy complications.
Methods
The retrospective cohort study used 10 years of linked data extracted from a regional health district’s databank. Strict inclusion/exclusion criteria were applied to the core dataset. There were six steps to the method: 1) writing data extraction code, 2) data collection, 3) data processing and refinement. 4) Datasets were prepared for linking, 5) deterministic linkage was used to produce final linked dataset and 6) combined dataset was analysed. Throughout the process of data management and linking a commitment to data sovereignty was upheld.
Results
Numerous challenges were faced when linking health data. Comprehensive solutions that were both systematic and repeatable were developed. For example, the creation of Clinical Phases of Care, a window of 28-days of care starting at arrival date of initial ED presentation. Clinical Phases of Care increased opportunity for higher linking yield, and mitigated issues with missing data and absence of linking terms. Challenges with handling big data, multiple supplies, and data variables not available or incorrectly formatted, were resolved by using statistical software.
Conclusions
Using an exemplar, methods of data management and linking have been shared, a process that could be directly transferred to other ED presentations. Key lessons for data linking strategies have been shared, providing clinical practitioners, researchers, decision makers and managers with a ‘how to guide’ on data management and linkage to audit and inform best practice and health policy.
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