Changes in Emergency Department Practices After Implementation of a Standardized Heavy Menstrual Bleeding Guideline

The aim of the study is to assess the effect of an emergency department (ED) standardized clinical guideline for adolescent heavy menstrual bleeding on the rate of return ED visits and ED provider history-taking and management of this condition.

This was a retrospective cohort study. Patients less than 18 years old presenting to a single academic children's hospital ED between 2010 and 2020 with a chief complaint of heavy menstrual bleeding were included. Patient demographics were collected, along with a 10-point scale of provider documentation of specific medical and menstrual history components and required laboratory workup. Planned treatment plans were collected, as well as hospital admissions and return ED visits (within 3 weeks).

Total number of patients was 267 (n = 106 pre- and n = 161 post-), with similar distribution of age ranges between groups (14.6 [2.2] and 14.5 [2.0], P  = 0.73). On the 10-point scale of required history and laboratory evaluations, postimplementation patients received 1.9 more points than the precohort ( P  < 0.001). Age (-0.22 [95% confidence interval {CI} -0.36 to -0.08]) and evaluation by a trainee physician (0.75, [95% CI 0.09 to 1.41]) were also associated with significant differences in point totals. Documentation of outpatient follow-up with primary care physician or an adolescent medicine/gynecology specialist significantly increased (50% and 90% P  < 0.001). Implementation was associated with a decrease in ED return visits in multivariate analysis (odds ratio 0.27, [95% CI 0.08 to 0.92], P  = 0.036).

Implementation of a clinical guideline pathway improved provider documentation and history taking, increased referrals to specialist care, and significantly decreased return ED visits within 3 weeks for heavy menstrual bleeding complaints.