Nonurgent Emergency Department Use During Pregnancy

Abstract

INTRODUCTION: Efforts to lower cesarean delivery rates have largely been unsuccessful. At our community hospital, a multifaceted strategy was initiated to lower cesarean delivery rates, and we analyzed the results over a 4-year period.METHODS: Beginning in 2011, we reviewed cesarean delivery indications daily, initiated a physician and nursing education program, encouraged resident involvement, and implemented a laborist program. Cesarean delivery rates between January 2010 and June 2013 were calculated overall and per individual physician based on inpatient records. STATA 12.1 was used to calculate risk ratios of cesarean delivery by calendar year, which was compared using the x 2 test. To explore the effect of individual physicians, a sensitivity analysis was performed to remove the highest individual physician rates from the 2010 data and compare the results with 2013.RESULTS: Cesarean delivery rates decreased from 44.6% to 35.6% from 2010 to 2013 with a 20% lower risk of having a cesarean delivery overall (relative risk [RR] 0.80, 95% confidence interval [CI] 0.69-0.92; P5.001) and a 28% lower risk of having a primary cesarean delivery (RR 0.72, 95% CI 0.57-0.90; P5.003) ( Table 1). In 2010, the highest three individual rates were 72.0%, 63.8%, and 47.9%, accounting for 314 (22%) deliveries. After removing these physicians from the 2010 data set, there is no significant difference between 2010 and 2013 rates for primary CD (RR 0.87, 95% CI 0.69-1.11; P5.3) or cesarean delivery overall (RR 0.90, 95% CI 0.78-1.04; P5.1).CONCLUSION: Implementing a comprehensive strategy can dramatically lower cesarean delivery rates. Although many factors were involved, the effect of the individual physician should not be underestimated.

Emergency department visits for non-urgent conditions in Iran: a cross-sectional study

“…Age of patients was negatively associated with the number of visits to ED. This was consistent with the results of previous studies conducted in Malaysia,33 Canada,11 France,34 USA,35–40 Italy41 and Hawaii 42…”

Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status

“…Based on limited secondary data, pregnant high utilizers of the emergency department or of unscheduled, emergency obstetric services in labor and delivery triage units are more likely to be of minority race. They are also more likely to report histories of lower SES, recent abuse, higher stress, depression, lower self-esteem, and conditions like hyperemesis gravidarum, gestational diabetes, and preterm labor (Bloom, Curry, & Durham, 2007; Grajkowski, Dolinsky, Abbott, & Batig, 2016; Kilfoyle, Vrees, Matteson, Phipps, & Raker, 2014). …”