Early Pregnancy Assessment centers for care of pregnant patients: a before and after review on emergency department utilization

Early Pregnancy Assessment Clinics provide gold-standard care to patients experiencing complications of early pregnancy, but their impact on emergency department (ED) volumes and consultation practices are largely unknown. The primary objective was to assess the volume of patients experiencing complications of early pregnancy presenting to the ED before and after the opening of an Early Pregnancy Assessment Clinic in Saskatoon, Saskatchewan. Secondary outcomes included inpatient prescribing practices and evaluation of Early Pregnancy Assessment Clinic referral patterns.

We performed a health records review including all patients presenting to 3 Saskatoon-area EDs in the 6 months before and after the Early Pregnancy Assessment Clinic opening and examined all referrals to the center in the first 6 months of its opening. Charts were excluded if patients were directly presenting for a specialist service, were admitted, and were presenting with complications unrelated to fetal outcomes. We calculated descriptive statistics and compared using z tests.

We identified 1242 charts, of which 757 met eligibility criteria. There were 393 visits pre-opening and 364 visits post-opening. However, only 33% of eligible patients were referred to the Early Pregnancy Assessment Clinic in the 6-month period after it was opened. Direct referrals to obstetrics decreased 39.9% from 20.1% to 12.1% (p = 0.002).

While patient visits were only moderately reduced and return visits were the same in the pre- and post- opening periods, the number of inpatient consults to obstetrics and gynecology were significantly reduced. This is clinically important in reducing the burden of in-hospital consults and allowing for greater flow through the ED while providing patient-centered care.