Developing Evidence-Based Implementation Strategies for the Management of Women With Early Pregnancy Bleeding in the Emergency Department: A Multi-Method Study.
Baylie Trostian, Kate Curtis, Andrea McCloughen
PMID 40211611WHAT IT FOUND
In emergency departments, 29.4% of women with early pregnancy bleeding had no evidence of recommended care, and after-hours ultrasound and psychosocial support were common barriers.
Nurse-initiated protocols and clearer pathways were proposed.
Key findings
01In the linked cohort, 29.4% of women had no evidence of receiving any indicators of evidence-based care, and 9.4% were recorded as receiving four or more indicators.
02ED clinicians identified limited after-hours ultrasound access as a major barrier: 77.9% reported lack of ultrasound services outside office hours, 51.9% lack of trained clinicians, and 37.5% time constraints.
03Women seen by nurses had shorter wait times than women seen by doctors: nurse wait time 23 min and doctor wait time 50 min.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was conducted in one health district in Australia, so the findings may not apply to other places. Cohort data were retrospective and relied on documentation, so they cannot show what patients actually experienced. The clinician survey had a low response rate (21.8%) and used brief open-text responses rather than interviews, so it may not represent all emergency clinicians. The paper develops implementation strategies from existing data, but it does not report results of testing those strategies in practice. Care was measured against seven indicators developed by the authors from a scoping review, so the indicators may not capture all important aspects of early pregnancy bleeding care.
The easy way to misread this
Do not read this as proof that the proposed implementation strategies improve care or patient outcomes. The paper reports existing care patterns and clinician survey feedback, not results of an implemented intervention.