Nonurgent and urgent emergency department use during pregnancy: an observational study - 04/11/16

Doi : 10.1016/j.ajog.2016.10.013

Kimberly A. Kilfoyle, MD, MSCR ^a,^b,^⁎ , Roxanne Vrees, MD ^a, Christina A. Raker, ScD ^a, Kristen A. Matteson, MD, MPH ^a
^a Department of Obstetrics and Gynecology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI
^b Division of Women’s Primary Heath Care, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC

^∗Corresponding author: Kimberly A. Kilfoyle, MD, MSCR.

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Abstract

Background

Emergency department use is common among pregnant women. Nonurgent emergency department use may represent care that would be better provided by an established obstetric provider in an ambulatory setting.

Objective

The objective of the study was to identify sociodemographic factors associated with nonurgent emergency department use in pregnancy.

Study Design

This is a cross-sectional study of women recruited during their postpartum hospitalization. Data regarding prenatal care and emergency department visits were collected from medical records; participants completed a survey with questions regarding demographics and emergency department use. Urgency of an emergency department visit was prespecified based on a priori criteria abstracted from medical record review. Women with any nonurgent emergency department use were compared with women without nonurgent emergency department use. Logistic regression was performed to identify factors associated with nonurgent emergency department use.

Results

Two hundred thirty-three women participated in this study; 197 (84%) received care in the emergency department during pregnancy. Eighty-three women (35.6%) had at least 1 visit to the emergency department that was nonurgent. In a regression analysis, the increased odds of nonurgent emergency department use was associated with a preferred language other than English (odds ratio, 2.02; 95% confidence interval,1.01–4.05) and lack of private insurance (odds ratio, 5.55; 95% confidence interval, 2.54–12.12). The 2 most common reasons for presentation to the emergency department were concern that there was an emergency (45%) or being referred by a health care provider (36%).

Conclusion

Women frequently use the emergency department during pregnancy, including visits for nonurgent indications. Identifying risk factors for nonurgent emergency department use in pregnancy is important for identifying women likely to use the emergency department, including for nonurgent visits, and the development of strategies to decrease nonurgent emergency department utilization in pregnancy.

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Key words : emergency department, nonurgent emergency department use, pregnancy, prenatal care

Plan

Materials and Methods

Results

Comment

	Dr Kilfoyle was supported by institutional National Institutes of Health training grant T32 HD040672-15 during the time period this manuscript was written. She was not supported by this grant at the time the research was conducted.
	Dr Kilfoyle’s spouse was employed by Tedor Pharmaceuticals at the time that this research was conducted and at GlaxoSmithKline at the time that this manuscript was written. The other authors report no conflict of interest.
	Present address for Dr Kilfoyle: Department of Obstetrics and Gynecology and Women’s Health, Cambridge Health Alliance, Cambridge MA.
	Cite this article as: Kilfoyle KA, Vrees R, Raker CA, et al. Nonurgent and urgent emergency department use during pregnancy: an observational study. Am J Obstet Gynecol 2016;xxxxx-xx.