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Management of women referred to an acute gynecology unit: impact of an ultrasound‐based model of care
Author(s) -
Bignardi T.,
Burnet S.,
Alhamdan D.,
Lu C.,
Pardey J.,
Benzie R.,
Condous G.
Publication year - 2010
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.7523
Subject(s) - medicine , ultrasound , gynecology , prospective cohort study , obstetrics and gynaecology , surgery , pregnancy , radiology , biology , genetics
Objective To assess the impact of the introduction of an ultrasound‐based model of care for women with acute gynecological complications. Methods This was a prospective comparative study of women attending an ultrasound‐based acute gynecology unit (AGU) at the Nepean Hospital during a 6‐week period 4 months after the unit's inception (new model of care), and a group of women presenting at the hospital during a similar period 6 months immediately prior to the unit's inception (traditional model). In the new model of care, ultrasound was performed at the time of the initial assessment by a senior clinician. The main outcome measures were admission rates and occupied bed days. Results The study included 290 consecutive women with complete data, 133 before and 157 after the introduction of the AGU. Compared with the group presenting before establishment of the AGU, the group who attended the AGU had significantly lower admission rate (7% vs. 36%, P < 0.0001) and significantly shorter time to see a trainee gynecologist (mean, 172 vs. 205 min, P = 0.00089), time to ultrasound examination (mean, 199 vs. 533 min, P < 0.0001), length of stay as an outpatient (mean, 45 vs. 248 min, P < 0.0001), fewer occupied bed days (total, 30 vs. 85 days, P < 0.0001) and lower surgical intervention rates (12% vs. 29%, P = 0.00025). They also had significantly higher expectant management rate (26 vs. 8%, P = 0.00023). The extrapolated annual reduction in occupied bed days represented a total financial saving of $ 257 617 Australian dollars. Conclusions In the AGU, the availability of ultrasound carried out by a senior clinician with an interest in gynecological emergencies may lead to a reduction in admissions and improved outcomes. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.