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Changes in Emergency Department Practices After Implementation of a Standardized Heavy Menstrual Bleeding Guideline
Erin E Isaacson1, Rabab S Isa2, Maria C Monge3
1Department of Women's Health, Dell Medical School.
Pediatric Emergency Care
|January 9, 2025
Summary
Implementing a standardized clinical guideline for adolescent heavy menstrual bleeding in the emergency department (ED) improved provider documentation and reduced return ED visits. This guideline enhances care for young patients experiencing heavy menstrual bleeding.
Area of Science:
- Pediatrics
- Emergency Medicine
- Gynecology
Background:
- Adolescent heavy menstrual bleeding is a common emergency department (ED) presentation.
- Standardized clinical guidelines can improve the quality of care for specific conditions.
Purpose of the Study:
- To evaluate the impact of a new emergency department (ED) clinical guideline for adolescent heavy menstrual bleeding.
- To assess effects on return ED visits and provider documentation/management.
Main Methods:
- Retrospective cohort study of patients under 18 with heavy menstrual bleeding (2010-2020).
- Collected data on demographics, provider documentation (10-point scale), laboratory workup, treatment plans, admissions, and return ED visits within 3 weeks.
- Compared pre- and post-implementation cohorts.
Main Results:
- Post-implementation group showed significantly improved provider documentation scores (1.9 points higher, P < 0.001).
- Referrals for outpatient follow-up increased significantly (50% to 90%, P < 0.001).
- Implementation was associated with a significant decrease in return ED visits (OR 0.27, P = 0.036).
Conclusions:
- A standardized clinical guideline pathway effectively improved provider documentation and history-taking for adolescent heavy menstrual bleeding.
- The guideline led to increased referrals to specialist care.
- Crucially, the guideline significantly reduced the rate of return emergency department visits within three weeks.
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