Memtsa, Maria, Goodhart, Venetia, Ambler, Gareth, Brocklehurst, Peter, Keeney, Edna, Silverio, Sergio A 
ORCID: 0000-0001-7177-3471, Anastasiou, Zacharias, Round, Jeff, Khan, Nazim, Hall, Jennifer et al (show 4 more authors)
(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).
e0260534-.
ISSN 1932-6203, 1932-6203
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Differences in the organisation of early pregnancy units and the effect of senior clinician presence, volume of patients and.pdf - Published version Download (601kB) | Preview |
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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | Humans, Pregnancy Complications, Patient Admission, Prenatal Care, Prospective Studies, Pregnancy, Pregnancy Trimester, First, Adolescent, Adult, Physicians, Emergency Service, Hospital, Female |
| Divisions: | Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Population Health |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 25 May 2022 10:57 |
| Last Modified: | 16 Jun 2026 12:59 |
| DOI: | 10.1371/journal.pone.0260534 |
| Open Access URL: | https://doi.org/10.1371/journal.pone.0260534 |
| Related Websites: | |
| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3155474 |
| Disclaimer: | The University of Liverpool is not responsible for content contained on other websites from links within repository metadata. Please contact us if you notice anything that appears incorrect or inappropriate. |
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