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A Framework Proposal for Quality and Safety Measurement in Gynecologic Emergency Care
Arnaud Fauconnier1, Johan Provot, Isabelle Le Creff
1Université Paris-Saclay, UVSQ, Unité de recherche 7285, Risques cliniques et sécurité en santé des femmes et en santé périnatale (RISCQ), Montigny-le-Bretonneux, Centre Hospitalier Intercommunal de Poissy-Saint-Germain-en-Laye, Service de gynecologie & obstétrique, Poissy, Université Paris Diderot, Sorbonne Paris Cité, AP-HP; Inserm, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, Paris, Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, AUDIPOG, Université Claude Bernard Lyon 1, Laennec, Lyon, Service de Gynécologie Obstétrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, Service de Gynécologie Obstétrique Hôpital Lariboisière, Paris, Service de Gynécologie Obstétrique Hôpital Jeanne de Flandre CHRU, Lille, Service de Gynécologie Obstétrique CHI de Villeneuve-Saint-Georges, Villeneuve Saint-Georges, Service de Gynécologie, Obstétrique et Médecine de la Reproduction, CHU Cochin Paris, Université Paris Descartes, Paris Sorbonne Cité, Paris, Gynécologie chirurgicale, CHU de Rennes, Rennes, Service de gynécologie-obstétrique, hôpitaux de Nantes, CHU Hôtel-Dieu, Nantes, Université de Nantes, Nantes, Service de Gynécologie Obstétrique, hôpital de La Conception, Assistance publique-Hôpitaux de Marseille, Marseille, Service de gynécologie obstétrique, Hôpital Bichat, APHP, Paris, Université Diderot Paris, Paris, Unité de recherche EA 7285, Université Versailles St-Quentin (UVSQ), Montigny-le-Bretonneux, Centre Hospitalier Universitaire Hautepierre, Hôpital de Hautepierre, Strasbourg, Département de l'assurance qualité, de la gestion des risques et des droits du patient, hôpitaux Universitaires de Paris Nord Val de Seine, APHP, Paris, Unité d'Epidémiologie Clinique, URC Robert Debré, APHP, Paris, Inserm CIC-EC 1426; Inserm et Université Paris Diderot UMR 1123 ECEVE, Paris, Paris, Institut de recherche pour le développement (IRD), université Paris Descartes, UMR 196, CEPED, Paris, UMR 1153 Equipe EPOPé, INSERM, Paris, France; and CHR la Citadelle, Université de Liège, Belgium.
Potentially life-threatening gynecologic emergencies occur in 3% of women with acute pelvic pain. These conditions, including ectopic pregnancy and pelvic inflammatory disease, require urgent care and highlight areas for improving emergency department quality and safety.
Area of Science:
- Gynecology
- Emergency Medicine
- Public Health
Background:
- Acute pelvic pain is a common reason for emergency department visits.
- Identifying life-threatening gynecologic emergencies is crucial for timely intervention and patient outcomes.
Purpose of the Study:
- To define and assess the prevalence of potentially life-threatening gynecologic emergencies in women presenting with acute pelvic pain.
- To develop quality audit measures for emergency department care.
Main Methods:
- A mixed-methods multicenter study involving a modified Delphi procedure and a prospective case-cohort study.
- Health care professionals defined criteria for life-threatening conditions and near misses.
- Prevalence was assessed in women of reproductive age presenting with acute pelvic pain across 21 centers in France and Belgium.
Main Results:
- Eight gynecologic emergencies and 17 near-miss criteria were identified.
- Potentially life-threatening conditions were found in 3% (130/3,825) of women with acute pelvic pain.
- Common diagnoses included ectopic pregnancy with severe bleeding (42%), complex pelvic inflammatory disease (23%), and adnexal torsion (15%). Diagnostic errors were more frequent in life-threatening emergency cases.
Conclusions:
- Potentially life-threatening gynecologic emergencies represent high-risk conditions.
- These conditions provide a framework for improving quality and safety in emergency care.
- Focusing on these emergencies can enhance patient outcomes in emergency settings.
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