A comparison of two models of gynecology service consultation to the emergency department in an academic medical center.

Abstract

This study was undertaken to determine differences in resource use and outcomes when emergency department (ED) physicians consult the gynecology service routinely versus selectively. In July 2000, an ED policy of "routine" gynecology consultation for pregnant women less than 20 weeks' gestation with pain and/or bleeding complaints changed to a policy of "selective" consultation. Resource use and outcomes were compared for 222 women who received care during the 9 months before the protocol change with 268 women who presented during the 9 months after the protocol change. With selective consultation, patients receiving gynecology evaluations decreased from 74% to 39%. Return visits to the ED increased from 9% to 21%. Ultrasound studies performed by ED physicians and radiologists increased, whereas studies by gynecologists decreased. Patients waited longer and received more unnecessary human chorionic gonadotropin studies. A policy of selective gynecology consultation, compared with routine gynecology consultation in the ED, increases diagnostic study resource use and patient length of stay.