Initiation of Emergency Departments (ED) Based Dilatation and Evacuation (D&E) Procedures

2.50
Hdl Handle:
http://hdl.handle.net/10755/162811
Type:
Presentation
Title:
Initiation of Emergency Departments (ED) Based Dilatation and Evacuation (D&E) Procedures
Abstract:
Initiation of Emergency Departments (ED) Based Dilatation and Evacuation (D&E) Procedures
Conference Sponsor:Emergency Nurses Association
Conference Year:1997
Author:Meunier-Sham, Joan, RN MS
Contact Address:, USA
Co-Authors:John C. Brancato, MD; Benjamin J. Kerman, MD; Vilma E. Ruddock, MD; and Barbara A. Ryan-McNeil, RN
Clinical Topic: Initiation of ED based D&E procedure was met with staff concern about the potential patient volume and flow, as well as concern about the ability to deliver supportive care to patients.

Process of Implementation: All patients who had a D&E done in the first year of an ED based protocol in an inner city, Level I trauma center, were enrolled. The protocol consisted of the D&E being done by OB/GYN; all other aspects of care were performed by existing ED personnel. Charts were reviewed at least weekly and patients were queried by phone or mail using a closed-question survey with 1 free-text response to determine complications and patient satisfaction.

Outcomes: 99 D&Es were done in the ED from 1/9/96 û 1/11/97. Median patient age was 26 (range 13 û 43 years) and the median length of time start of procedure to discharge was 115 minutes. Complication data was available for 62/99 (63%) of patients. Complications occurred in 3/62 (4.8%) (endometritis û 2 patients admitted, 1 patient treated as an outpatient). Satisfactions data was obtained from 67 of 99 (68%) patients. Patients rated the ED experience as good or excellent in 58/67 (87%) of cases. Patients rated the experience as fair or poor in 9/67 (13%) of cases. Twenty-two percent (2/9) of patients with fair or poor ratings had negative clinical outcomes unrelated to the procedure (missed or ruptured ectopic pregnancy). The most frequently cited area for improvement was to decrease waiting time 13/67 (19%). In general, women were most receptive to phone follow-up and often had additional questions or concerns 20/67 (30%).

Recommendations for Clinical Practice: Recommendations for clinical practice include (1) Incorporation of patient follow-up for D&E patients into the follow-up nurse/staff nurse role; (2) Continued monitoring of program to ascertain if expansion of program is feasible with existing staffing levels; (3) Potential establishment of a fast-track for OB/GYN patients; (4) Further research to compare complications, costs and patient satisfaction with patients having ED-based D&Es versus D&E procedures performed in the operating room. [Clinical Poster Presentation]
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleInitiation of Emergency Departments (ED) Based Dilatation and Evacuation (D&E) Proceduresen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162811-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Initiation of Emergency Departments (ED) Based Dilatation and Evacuation (D&amp;E) Procedures</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">1997</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Meunier-Sham, Joan, RN MS</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">res@ena.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">John C. Brancato, MD; Benjamin J. Kerman, MD; Vilma E. Ruddock, MD; and Barbara A. Ryan-McNeil, RN</td></tr><tr><td colspan="2" class="item-abstract">Clinical Topic: Initiation of ED based D&amp;E procedure was met with staff concern about the potential patient volume and flow, as well as concern about the ability to deliver supportive care to patients.<br/><br/>Process of Implementation: All patients who had a D&amp;E done in the first year of an ED based protocol in an inner city, Level I trauma center, were enrolled. The protocol consisted of the D&amp;E being done by OB/GYN; all other aspects of care were performed by existing ED personnel. Charts were reviewed at least weekly and patients were queried by phone or mail using a closed-question survey with 1 free-text response to determine complications and patient satisfaction.<br/><br/>Outcomes: 99 D&amp;Es were done in the ED from 1/9/96 &ucirc; 1/11/97. Median patient age was 26 (range 13 &ucirc; 43 years) and the median length of time start of procedure to discharge was 115 minutes. Complication data was available for 62/99 (63%) of patients. Complications occurred in 3/62 (4.8%) (endometritis &ucirc; 2 patients admitted, 1 patient treated as an outpatient). Satisfactions data was obtained from 67 of 99 (68%) patients. Patients rated the ED experience as good or excellent in 58/67 (87%) of cases. Patients rated the experience as fair or poor in 9/67 (13%) of cases. Twenty-two percent (2/9) of patients with fair or poor ratings had negative clinical outcomes unrelated to the procedure (missed or ruptured ectopic pregnancy). The most frequently cited area for improvement was to decrease waiting time 13/67 (19%). In general, women were most receptive to phone follow-up and often had additional questions or concerns 20/67 (30%).<br/><br/>Recommendations for Clinical Practice: Recommendations for clinical practice include (1) Incorporation of patient follow-up for D&amp;E patients into the follow-up nurse/staff nurse role; (2) Continued monitoring of program to ascertain if expansion of program is feasible with existing staffing levels; (3) Potential establishment of a fast-track for OB/GYN patients; (4) Further research to compare complications, costs and patient satisfaction with patients having ED-based D&amp;Es versus D&amp;E procedures performed in the operating room. [Clinical Poster Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:34:34Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:34:34Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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