Nonurgent and urgent emergency department use during pregnancy: an observational study

Abstract

Background Emergency department use is common among pregnant women. Non-urgent emergency department use may represent care that would be better provided by an established obstetric provider in an ambulatory setting. Objective To identify socio-demographic factors associated with non-urgent emergency department use in pregnancy. Study Design This is a cross-sectional study of women recruited during their postpartum hospitalization. Data regarding prenatal care and emergency department visits was collected from medical records; participants completed a survey with questions regarding demographics and emergency department use. Urgency of an emergency department visit was pre-specified based on a-priori criteria abstracted from medical record review. Women with any non-urgent emergency department use were compared with women without non-urgent emergency department use. Logistic regression was performed to identify factors associated with non-urgent emergency department use. Results Two hundred and thirty-three women participated in this study; 197 (84%) received care in the emergency department during pregnancy. Eighty-three (35.6%) women had at least one visit to the emergency department that was non-urgent. In regression analysis, increased odds of non-urgent emergency department use was associated with a preferred language other than English (OR 2.02, 95% CI 1.01-4.05) and lack of private insurance (OR 5.55, 95% CI 2.54-12.12). The two most common reasons for presentation to the emergency department were concern that there was an emergency (45%) or being referred by a healthcare provider (36%). Conclusion Women frequently use the emergency department during pregnancy, including visits for non-urgent indications. Identifying risk factors for non-urgent emergency department use in pregnancy is important for identifying women likely to use the emergency department, including for non-urgent visits, and the development of strategies to decrease non-urgent emergency department utilization in pregnancy.

The impact of COVID‐19 lockdown on admission to gynecological emergency departments: Results from a multicenter Italian study

“…EDs are increasingly being utilized for non‐emergent medical care, especially during pregnancy 8 . Up to one‐third of patients seen in the ED have “non‐urgent” problems that could have potentially been addressed in an outpatient setting 9 .…”

Burden of Unplanned Antenatal Visits in a Tertiary Hospital in Nigeria: Making a Case for an Improved Referral System

“…Unplanned visits to the emergency departments or labour rooms are common among pregnant women [17][18]. Despite the fact that they have a programmed scheme of care, half of the pregnant women in a cohort studied visited the emergency room for care during the prenatal period [19], with a proportion of these pregnant mothers using the emergency department for non-urgent reasons. This has been partly linked to the poor performance of the referral system in many developing countries, including Nigeria [20].…”

Training in Emergency Obstetrics: A Needs Assessment of U.S. Emergency Medicine Program Directors

“…1 Pregnant women often present to the ED because they feel they are having an emergency. 2 Being able to manage both emergent and non-emergent pregnancies is a hallmark of an emergency physician (EP). 2 Currently there are no formal standardized teaching requirements beyond the minimum mandatory requirement of 10 low-risk, normal spontaneous vaginal deliveries 3 (NSVD) and the assumption that obstetrical knowledge is a core principle of emergency medicine (EM), which means that EPs must achieve this knowledge in order to practice after residency.…”

“…3 In addition, the 2016 Model of the Clinical Practice of Emergency Medicine includes both normal pregnancy as well as complications of pregnancy, and labor and delivery and the postpartum period as a part of the core content of EM. 4 As there have been no studies to date evaluating the incidence of either NSVD or complications of labor and delivery in EDs, 2 it is not clear whether current requirements adequately prepare residents for independent practice in these areas.…”