RCOG World Congress 2023

Developing an emergency gynaecological service: a multidisciplinary approach

Introduction

A multi-disciplinary approach to patient care allows for more efficient and effective outcomes for both patients and service providers. On recognition of the need and benefit of a gynaecology emergency service (GEC) we set about creating a ‘one-stop’ GEC, allowing patients to receive a clinical review, imaging where appropriate and follow-up within one attendance. Critical to setting up the service was identifying stakeholders. We assessed the effectiveness of the GEC through a series of audit and questionnaires directed at the service users including healthcare professionals (HCP) and patient.

Aims

-Design a multidisciplinary clinic to facilitate a complete, same day gynaecological assessment

-Improve effectiveness of the clinic based on qualitative and quantitative assessment of patient and care provider experiences.

Methods

-Retrospective audit of 188 patient attendances to GEC over a three month time period – clinical notes and PACS imaging results reviewed to ascertain referral pathway, time awaiting review, time from admission to discharge, imaging required and performed

-Attained qualitative data from HCPs and patients to inform and design clinic inclusive of location, opening times, resources required and referral criteria.

Feedback from HCPs and patients:

SHO level: Excellent location for reviewing and examining patients as dedicated space, however staffing levels and workload can be suboptimal

Reg level: Supervision can be variable and patient safety concerns exist when staffing levels are suboptimal

Nursing level: Feel well supported by colleagues however feel patient waiting time to be seen is currently too long

Patient feedback: Very satisfied with service and interactions with staff with 100% saying these items were either good or very good.

Key Findings

-62.2% of patients were seen by a doctor within one hour of arrival, of which 37.2% were within thirty minutes

-Over one half of patients were referred from the emergency department

-10% of patients required hospital admission

-45.7% of patients required same day USS, of which 43% were abnormal

-The leading cause for referral was pain

Conclusions

Setting up an emergency clinic has numerous stakeholders and these stakeholders have different priorities as seen in the feedback section. A service should be designed around stakeholders and provide a service that is equitable and relevant to the population group we are serving.

RCOG World Congress 2023

Developing an emergency gynaecological service: a multidisciplinary approach

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