RCOG World Congress 2023

Developing a Gynaecology Same Day Emergency Care Service: Improving care for women

R Gisby, D Rampersad, V Croll, K Hayes, M Ghosh

AIM:

To improve care for women presenting to the Emergency Department (ED) with Hyperemesis Gravidarum (HG)

OBJECTIVES:

1.To develop a Same Day Emergency Care (SDEC) service for Acute Gynaecology patients

2.To provide a direct access pathway to speciality care for women presenting with Hyperemesis Gravidarum

3.To enable admission avoidance by managing appropriate patients in an ambulatory setting

4.To improve patient flow through the ED

BACKGROUND:

·In the year prior to launching the unit, an average of 21.3 patients attending ED per month with hyperemesis in this London tertiary referral centre.

·Average length of stay in ED 5 hours and 46 minutes

·The NHS England operational plan encourages the development of SDEC units to improve access to specialty care

METHOD:

We successfully applied for £18,973 of funding from Health Education England, to enable the acquisition and training of clinical staff to develop a Gynaecology SDEC unit, initially focussed on women with HG.

The development of the unit was over a 5 month period from January to May 2022, and it was subsequently launched to initially receive referrals directly from ED clinical staff.

MEASURES OF SUCCESS:

A reduction in the number of HG patients and length of stay seen in the ED

A reduction in the length of stay in ED and number of hospital admissions with HG

Availability of the SDEC unit – aiming for 12 hours a day, 7 days a week

RESULTS:

AVAILABILITY OF THE SERVICE

We initially opened the SDEC unit 8 hours a day, 5 days a week based on the staffing capacity, based on the predicted demand for the service as well as capacity based on staffing levels

UTILISATION OF THE PATHWAY

-In the year since launching the pathway, we saw a steady increase in utilisation indicating successful embedding

RATE OF ADMISSION

There has been a significant reduction in admission rate for patients attending ED with HG (a 30% reduction from 24% pre launch, 16.5% post launch, p<0.01)

Of patients attending SDEC, only 2.88% required overnight admission to hospital

There has been a trend towards a reduction in number of patients attending ED with HG per month – from 21.3 per month pre launch, 19.6 per month, which represents a reduction of length of stay of 9 hours 48 minutes per month

CONCLUSIONS:

With the development of the new SDEC pathway, there has been a significant reduction in the rate of hospital admission for patients attending the ED with HG.

There is a trend towards a reduction in number of patients attending the ED, with an increase in number of patients receiving direct to specialty care.

This helps to improve flow of patients through the ED, as well as significantly improving the patient experience for these women

NEXT STEPS

Patient feedback is currently being collected.

As the pathway has become more established, it will be further expanded by allowing direct access via GP and 111 referrals. This will allow greater access to the pathway for appropriate patients and further reduce footfall through the ED

There is scope in the future to expand the pathway to care for other acute Gynaecology conditions

With thanks to the Gynaecology & Emergency Department clinical and administrative staff for their support in establishing the unit, as well as Health Education England for the funding to allow the pathway to be developed

Contact: Rhian.gisby2@nhs.net

RCOG World Congress 2023

Developing a Gynaecology Same Day Emergency Care Service: Improving care for women

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