Impact of consultant-led care in early pregnancy unit

Tan, Toh Lick; Khoo, Cheen Leen; Sawant, S

doi:10.3109/01443615.2014.896324

Cited by 6 publications

(4 citation statements)

References 2 publications

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“…We could not find evidence to support practices of multidisciplinary working or particular health-care professionals leading EPAU services, as reported in previous studies. 65 However, our study provides further evidence to support the claim by Edey et al 11 that EPAUs are a health-care success and are needed and valued by women who use them.…”

Section: Qualitative Interviewssupporting

confidence: 76%

“…Previous evaluations of EPAUs have often focused on one EPAU 63 or one aspect of how EPAUs operate, such as multidisciplinary working 64 or staffing structures. 12,65 Our study provides insight into a crosssection of a variety of individual EPAUs, and also their configuration and working practices. We could not find evidence to support practices of multidisciplinary working or particular health-care professionals leading EPAU services, as reported in previous studies.…”

Section: Qualitative Interviewsmentioning

confidence: 99%

“…The range of women's emotional experiences while receiving care in the EPAU has, until now, been largely unexplored, as similar studies have mainly focused on different aspects of service evaluation. 12,64,65 The novelty of this study and its subsequent analysis has been the clear mapping of women's psychoemotional journeys overlaid onto their clinical care pathways, showing how varied pathways can be, yet also demonstrating distinct similarities across all women who present to EPAUs with early pregnancy complications (e.g. anxiety, which was reported and recalled by every woman we interviewed).…”

Section: Qualitative Interviewsmentioning

confidence: 99%

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Variations in the organisation of and outcomes from Early Pregnancy Assessment Units: the VESPA mixed-methods study

Memtsa

Goodhart

Ambler

et al. 2020

Health Serv Deliv Res

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Background Early pregnancy complications are common and account for the largest proportion of emergency work in gynaecology. Although early pregnancy assessment units operate in most UK acute hospitals, recent National Institute of Health and Care Excellence guidance emphasised the need for more research to identify configurations that provide the optimal balance between cost-effectiveness, clinical effectiveness and service- and patient-centred outcomes [National Institute for Health and Care Excellence (NICE). Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management. URL: http://guidance.nice.org.uk/CG154 (accessed 23 March 2016)]. Objectives The primary aim was to test the hypothesis that the rate of hospital admissions for early pregnancy complications is lower in early pregnancy assessment units with high consultant presence than in units with low consultant presence. The key secondary objectives were to assess the effect of increased consultant presence on other clinical outcomes, to explore patient satisfaction with the quality of care and to make evidence-based recommendations about the future configuration of UK early pregnancy assessment units. Design The Variations in the organisations of Early Pregnancy Assessment Units in the UK and their effects on clinical, Service and PAtient-centred outcomes (VESPA) study employed a multimethods approach and included a prospective cohort study of women attending early pregnancy assessment units to measure clinical outcomes, an economic evaluation, a patient satisfaction survey, qualitative interviews with service users, an early pregnancy assessment unit staff survey and a hospital emergency care audit. Setting The study was conducted in 44 early pregnancy assessment units across the UK. Participants Participants were pregnant women (aged ≥ 16 years) attending the early pregnancy assessment units or other hospital emergency services because of suspected early pregnancy complications. Staff members directly involved in providing early pregnancy care completed the staff survey. Main outcome measure Emergency hospital admissions as a proportion of women attending the participating early pregnancy assessment units. Methods Data sources – demographic and routine clinical data were collected from all women attending the early pregnancy assessment units. For women who provided consent to complete the questionnaires, clinical data and questionnaires were linked using the women’s study number. Data analysis and results reporting – the relationships between clinical outcomes and consultant presence, unit volume and weekend opening hours were investigated using appropriate regression models. Qualitative interviews with women, and patient and staff satisfaction, health economic and workforce analyses were also undertaken, accounting for consultant presence, unit volume and weekend opening hours. Results We collected clinical data from 6606 women. There was no evidence of an association between admission rate and consultant presence (p = 0.497). Health economic evaluation and workforce analysis data strands indicated that lower-volume units with no consultant presence were associated with lower costs than their alternatives. Limitations The relatively low level of direct consultant involvement could explain the lack of significant impact on quality of care. We were also unable to estimate the potential impact of factors such as scanning practices, level of supervision, quality of ultrasound equipment and clinical care pathway protocols. Conclusions We have shown that consultant presence in the early pregnancy assessment unit has no significant impact on key outcomes, such as the proportion of women admitted to hospital as an emergency, pregnancy of unknown location rates, ratio of new to follow-up visits, negative laparoscopy rate and patient satisfaction. All data strands indicate that low-volume units run by senior or specialist nurses and supported by sonographers and consultants may represent the optimal early pregnancy assessment unit configuration. Future work Our results show that further research is needed to assess the potential impact of enhanced clinical and ultrasound training on the performance of all disciplines working in early pregnancy assessment units. Trial registration Current Controlled Trials ISRCTN10728897. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 46. See the NIHR Journals Library website for further project information.

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Section: Qualitative Interviewssupporting

confidence: 76%

Section: Qualitative Interviewsmentioning

confidence: 99%

Section: Qualitative Interviewsmentioning

confidence: 99%

See 1 more Smart Citation

Variations in the organisation of and outcomes from Early Pregnancy Assessment Units: the VESPA mixed-methods study

Memtsa

Goodhart

Ambler

et al. 2020

Health Serv Deliv Res

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show abstract

“…The few evaluations of EPAUs that do exist have focused on one EPAU, 15 one aspect of how EPAUs operate, such as multidisciplinary working, 16 or staffing structures 17 , 18 or only on women with pregnancy loss. 8 No previous studies have brought together all these factors to evaluate women’s experiences with the services they use, making our research unique.…”

Section: Discussionmentioning

confidence: 99%

Women's experiences of early pregnancy assessment unit services: a qualitative investigation

Hall

Silverio

Barrett

et al. 2021

BJOG

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Objective To explore the experiences of women who had used an Early Pregnancy Assessment Unit (EPAU) service in the UK and make recommendations for their improvement. Design Qualitative interview study. Setting Early Pregnancy Assessment Units in the UK. Sample A maximum variation sample of women who had consented to be interviewed having attended one of 26 EPAUs involved in the VESPA study in 2018. Methods In‐depth telephone interviews with 38 women. A thematic framework analysis was conducted, with a focus on how experiences varied according to EPAU service configuration and clinical pathway. Main outcome measures Women's experiences of EPAU services. Results We found that EPAUs are highly valued, and women's experiences were generally positive. However, women reported a range of issues that negatively affected their experience. These included difficulties accessing the service, insensitive management of the investigation and treatment options of pregnancy loss, poor communication, insufficient information and a lack of support for their psychological health. These issues were not strongly associated with EPAU configuration or clinical pathway. Conclusions Recommendations to improve women's experiences include the separation of EPAUs from general maternity services, and we make suggestions on how to remove barriers to access by reviewing opening hours, how to provide sensitive patient management, such as automatically cancelling appointments and scans following pregnancy loss, and how to improve communication, both with women and their partners as well as with other parts of the health service. Tweetable abstract Early Pregnancy Assessment Units are highly valued by women but aspects of their care experiences, particularly around sensitive management of pregnancy loss, could be improved.

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Emotional experiences of women who access early pregnancy assessment units: a qualitative investigation

Silverio

Memtsa

Barrett

et al. 2022

Journal of Psychosomatic Obstetrics & Gynecology

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Impact of consultant-led care in early pregnancy unit

Cited by 6 publications

References 2 publications

Variations in the organisation of and outcomes from Early Pregnancy Assessment Units: the VESPA mixed-methods study

Variations in the organisation of and outcomes from Early Pregnancy Assessment Units: the VESPA mixed-methods study

Women's experiences of early pregnancy assessment unit services: a qualitative investigation

Emotional experiences of women who access early pregnancy assessment units: a qualitative investigation

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