An Audit of Emergency Gynaecological Admission in a Regional Hospital

Abstract

Objectives: To identify the disease entity of patients admitted to gynaecological ward through
emergency department. To identify areas which can be improved through such an audit. Methods: The study was conducted at a regional hospital in Hong Kong. During 1st January and 31st December 1996, all patients admitted to gynaecological ward through the emergency department were included. Information on the disease entity, length of hospital stay, accuracy of admission diagnosis, especially the diagnosis of ectopic pregnancy were retrieved. Feasibility of outpatient management was assessed and patients who were admitted for less than 24 hours without surgical intervention were regarded suitable for such management. Results: In this study, 1,993 patients were included. 58.3% of patients had early pregnancy complications and majority of these patients (44.8%) could be referred to Early Pregnancy Assessment Clinic. Menstrual disorder, constituted 16.3% of admission, was the next most common problem in the cohort. Sixty-seven patients had ectopic pregnancy and 58.2% of the diagnoses were not made at the Accident & Emergency Department. Twelve (17.9%) patients were initially admitted to surgical and medical ward with diagnoses such as abdominal pain, anaemia and convulsion. Up to 24% of the clinical diagnosis on admission was incorrect and 24% did not have any clinical diagnoses on admission. Conclusions: A large number of gynaecological patients presented to emergency departments can be referred to the outpatient clinic. This will reduce total hospital admissions and improve patient's satisfaction.
Problems identified in this study include high incidence of undiagnosed ectopic pregnancy and inaccurate admission diagnoses. Diagnosis of ectopic pregnancy can be improved with careful enquiry about menstrual history, introduction of sensitive one-step urine pregnancy test and transvaginal ultrasound in the emergency department. (HKJGOM 2000 ; 1 : 81 - 85)