Differences in the organisation of early pregnancy units and the effect of senior clinician presence, volume of patients and weekend opening on emergency hospital admissions: findings from the VESPA Study

Maria Memtsa; Venetia Goodhart; Gareth Ambler; Peter Brocklehurst; Edna Keeney; Sergio A Silverio; Zacharias Anastasiou; Jeff Round; Nazim Khan; Jennifer Hall; Geraldine Barrett; Ruth Bender-Atik; Judith Stephenson; Davor Jurkovic

doi:10.1371/journal.pone.0260534

Differences in the organisation of early pregnancy units and the effect of senior clinician presence, volume of patients and weekend opening on emergency hospital admissions: findings from the VESPA Study

Maria Memtsa, Venetia Goodhart, Gareth Ambler, Peter Brocklehurst, Edna Keeney, Sergio A Silverio, Zacharias Anastasiou, Jeff Round, Nazim Khan, Jennifer Hall, Geraldine Barrett, Ruth Bender-Atik, Judith Stephenson, Davor Jurkovic

Birmingham Clinical Trials Unit

Research output: Contribution to journal › Article › peer-review

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Abstract

OBJECTIVE: To determine whether the participation of consultant gynaecologists in delivering early pregnancy care results in a lower rate of acute hospital admissions.

DESIGN: Prospective cohort study and emergency hospital care audit; data were collected as part of the national prospective mixed-methods VESPA study on the "Variations in the organization of EPAUs in the UK and their effects on clinical, Service and PAtient-centred outcomes".

SETTING: 44 Early Pregnancy Assessment Units (EPAUs) across the UK randomly selected in balanced numbers from eight pre-defined mutually exclusive strata.

PARTICIPANTS: 6606 pregnant women (≥16 years old) with suspected first trimester pregnancy complications attending the participating EPAUs or Emergency Departments (ED) from December 2016 to July 2017.

EXPOSURES: Planned and actual senior clinician presence, unit size, and weekend opening.

MAIN OUTCOME MEASURES: Unplanned admissions to hospital following any visit for investigations or treatment for first trimester complications as a proportion of women attending EPAUs.

RESULTS: 205/6397 (3.2%; 95% CI 2.8-3.7) women were admitted following their EPAU attendance. The admission rate among 44 units ranged from 0% to 13.7% (median 2.8). Neither planned senior clinician presence (p = 0.874) nor unit volume (p = 0.247) were associated with lower admission rates from EPAU, whilst EPAU opening over the weekend resulted in lower admission rates (p = 0.027). 1445/5464 (26.4%; 95%CI 25.3 to 27.6) women were admitted from ED. There was little evidence of an association with planned senior clinician time (p = 0.280) or unit volume (p = 0.647). Keeping an EPAU open over the weekend for an additional hour was associated with 2.4% (95% CI 0.1% to 4.7%) lower odds of an emergency admission from ED.

CONCLUSIONS: Involvement of senior clinicians in delivering early pregnancy care has no significant impact on emergency hospital admissions for early pregnancy complications. Weekend opening, however, may be an effective way of reducing emergency admissions from ED.

Original language	English
Article number	e0260534
Number of pages	15
Journal	PLoS ONE
Volume	16
Issue number	11
DOIs	https://doi.org/10.1371/journal.pone.0260534
Publication status	Published - 30 Nov 2021

Keywords

Adolescent
Adult
Emergency Service, Hospital
Female
Humans
Patient Admission
Physicians
Pregnancy
Pregnancy Complications/epidemiology
Pregnancy Trimester, First
Prenatal Care
Prospective Studies

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Memtsa, M., Goodhart, V., Ambler, G., Brocklehurst, P., Keeney, E., Silverio, S. A., Anastasiou, Z., Round, J., Khan, N., Hall, J., Barrett, G., Bender-Atik, R., Stephenson, J., & Jurkovic, D. (2021). Differences in the organisation of early pregnancy units and the effect of senior clinician presence, volume of patients and weekend opening on emergency hospital admissions: findings from the VESPA Study. PLoS ONE, 16(11), Article e0260534. https://doi.org/10.1371/journal.pone.0260534

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title = "Differences in the organisation of early pregnancy units and the effect of senior clinician presence, volume of patients and weekend opening on emergency hospital admissions: findings from the VESPA Study",

abstract = "OBJECTIVE: To determine whether the participation of consultant gynaecologists in delivering early pregnancy care results in a lower rate of acute hospital admissions.DESIGN: Prospective cohort study and emergency hospital care audit; data were collected as part of the national prospective mixed-methods VESPA study on the {"}Variations in the organization of EPAUs in the UK and their effects on clinical, Service and PAtient-centred outcomes{"}.SETTING: 44 Early Pregnancy Assessment Units (EPAUs) across the UK randomly selected in balanced numbers from eight pre-defined mutually exclusive strata.PARTICIPANTS: 6606 pregnant women (≥16 years old) with suspected first trimester pregnancy complications attending the participating EPAUs or Emergency Departments (ED) from December 2016 to July 2017.EXPOSURES: Planned and actual senior clinician presence, unit size, and weekend opening.MAIN OUTCOME MEASURES: Unplanned admissions to hospital following any visit for investigations or treatment for first trimester complications as a proportion of women attending EPAUs.RESULTS: 205/6397 (3.2%; 95% CI 2.8-3.7) women were admitted following their EPAU attendance. The admission rate among 44 units ranged from 0% to 13.7% (median 2.8). Neither planned senior clinician presence (p = 0.874) nor unit volume (p = 0.247) were associated with lower admission rates from EPAU, whilst EPAU opening over the weekend resulted in lower admission rates (p = 0.027). 1445/5464 (26.4%; 95%CI 25.3 to 27.6) women were admitted from ED. There was little evidence of an association with planned senior clinician time (p = 0.280) or unit volume (p = 0.647). Keeping an EPAU open over the weekend for an additional hour was associated with 2.4% (95% CI 0.1% to 4.7%) lower odds of an emergency admission from ED.CONCLUSIONS: Involvement of senior clinicians in delivering early pregnancy care has no significant impact on emergency hospital admissions for early pregnancy complications. Weekend opening, however, may be an effective way of reducing emergency admissions from ED.",

keywords = "Adolescent, Adult, Emergency Service, Hospital, Female, Humans, Patient Admission, Physicians, Pregnancy, Pregnancy Complications/epidemiology, Pregnancy Trimester, First, Prenatal Care, Prospective Studies",

author = "Maria Memtsa and Venetia Goodhart and Gareth Ambler and Peter Brocklehurst and Edna Keeney and Silverio, {Sergio A} and Zacharias Anastasiou and Jeff Round and Nazim Khan and Jennifer Hall and Geraldine Barrett and Ruth Bender-Atik and Judith Stephenson and Davor Jurkovic",

year = "2021",

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day = "30",

doi = "10.1371/journal.pone.0260534",

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Memtsa, M, Goodhart, V, Ambler, G, Brocklehurst, P, Keeney, E, Silverio, SA, Anastasiou, Z, Round, J, Khan, N, Hall, J, Barrett, G, Bender-Atik, R, Stephenson, J & Jurkovic, D 2021, 'Differences in the organisation of early pregnancy units and the effect of senior clinician presence, volume of patients and weekend opening on emergency hospital admissions: findings from the VESPA Study', PLoS ONE, vol. 16, no. 11, e0260534. https://doi.org/10.1371/journal.pone.0260534

Differences in the organisation of early pregnancy units and the effect of senior clinician presence, volume of patients and weekend opening on emergency hospital admissions: findings from the VESPA Study. / Memtsa, Maria; Goodhart, Venetia; Ambler, Gareth et al.
In: PLoS ONE, Vol. 16, No. 11, e0260534, 30.11.2021.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Differences in the organisation of early pregnancy units and the effect of senior clinician presence, volume of patients and weekend opening on emergency hospital admissions

T2 - findings from the VESPA Study

AU - Memtsa, Maria

AU - Goodhart, Venetia

AU - Ambler, Gareth

AU - Brocklehurst, Peter

AU - Keeney, Edna

AU - Silverio, Sergio A

AU - Anastasiou, Zacharias

AU - Round, Jeff

AU - Khan, Nazim

AU - Hall, Jennifer

AU - Barrett, Geraldine

AU - Bender-Atik, Ruth

AU - Stephenson, Judith

AU - Jurkovic, Davor

PY - 2021/11/30

Y1 - 2021/11/30

N2 - OBJECTIVE: To determine whether the participation of consultant gynaecologists in delivering early pregnancy care results in a lower rate of acute hospital admissions.DESIGN: Prospective cohort study and emergency hospital care audit; data were collected as part of the national prospective mixed-methods VESPA study on the "Variations in the organization of EPAUs in the UK and their effects on clinical, Service and PAtient-centred outcomes".SETTING: 44 Early Pregnancy Assessment Units (EPAUs) across the UK randomly selected in balanced numbers from eight pre-defined mutually exclusive strata.PARTICIPANTS: 6606 pregnant women (≥16 years old) with suspected first trimester pregnancy complications attending the participating EPAUs or Emergency Departments (ED) from December 2016 to July 2017.EXPOSURES: Planned and actual senior clinician presence, unit size, and weekend opening.MAIN OUTCOME MEASURES: Unplanned admissions to hospital following any visit for investigations or treatment for first trimester complications as a proportion of women attending EPAUs.RESULTS: 205/6397 (3.2%; 95% CI 2.8-3.7) women were admitted following their EPAU attendance. The admission rate among 44 units ranged from 0% to 13.7% (median 2.8). Neither planned senior clinician presence (p = 0.874) nor unit volume (p = 0.247) were associated with lower admission rates from EPAU, whilst EPAU opening over the weekend resulted in lower admission rates (p = 0.027). 1445/5464 (26.4%; 95%CI 25.3 to 27.6) women were admitted from ED. There was little evidence of an association with planned senior clinician time (p = 0.280) or unit volume (p = 0.647). Keeping an EPAU open over the weekend for an additional hour was associated with 2.4% (95% CI 0.1% to 4.7%) lower odds of an emergency admission from ED.CONCLUSIONS: Involvement of senior clinicians in delivering early pregnancy care has no significant impact on emergency hospital admissions for early pregnancy complications. Weekend opening, however, may be an effective way of reducing emergency admissions from ED.

AB - OBJECTIVE: To determine whether the participation of consultant gynaecologists in delivering early pregnancy care results in a lower rate of acute hospital admissions.DESIGN: Prospective cohort study and emergency hospital care audit; data were collected as part of the national prospective mixed-methods VESPA study on the "Variations in the organization of EPAUs in the UK and their effects on clinical, Service and PAtient-centred outcomes".SETTING: 44 Early Pregnancy Assessment Units (EPAUs) across the UK randomly selected in balanced numbers from eight pre-defined mutually exclusive strata.PARTICIPANTS: 6606 pregnant women (≥16 years old) with suspected first trimester pregnancy complications attending the participating EPAUs or Emergency Departments (ED) from December 2016 to July 2017.EXPOSURES: Planned and actual senior clinician presence, unit size, and weekend opening.MAIN OUTCOME MEASURES: Unplanned admissions to hospital following any visit for investigations or treatment for first trimester complications as a proportion of women attending EPAUs.RESULTS: 205/6397 (3.2%; 95% CI 2.8-3.7) women were admitted following their EPAU attendance. The admission rate among 44 units ranged from 0% to 13.7% (median 2.8). Neither planned senior clinician presence (p = 0.874) nor unit volume (p = 0.247) were associated with lower admission rates from EPAU, whilst EPAU opening over the weekend resulted in lower admission rates (p = 0.027). 1445/5464 (26.4%; 95%CI 25.3 to 27.6) women were admitted from ED. There was little evidence of an association with planned senior clinician time (p = 0.280) or unit volume (p = 0.647). Keeping an EPAU open over the weekend for an additional hour was associated with 2.4% (95% CI 0.1% to 4.7%) lower odds of an emergency admission from ED.CONCLUSIONS: Involvement of senior clinicians in delivering early pregnancy care has no significant impact on emergency hospital admissions for early pregnancy complications. Weekend opening, however, may be an effective way of reducing emergency admissions from ED.

KW - Adolescent

KW - Adult

KW - Emergency Service, Hospital

KW - Female

KW - Humans

KW - Patient Admission

KW - Physicians

KW - Pregnancy

KW - Pregnancy Complications/epidemiology

KW - Pregnancy Trimester, First

KW - Prenatal Care

KW - Prospective Studies

U2 - 10.1371/journal.pone.0260534

DO - 10.1371/journal.pone.0260534

M3 - Article

C2 - 34847201

SN - 1932-6203

VL - 16

JO - PLoS ONE

JF - PLoS ONE

IS - 11

M1 - e0260534

ER -