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This was an innovation project supported by the Better Care Victoria Innovation Fund.
Lead organisation
The Royal Women’s Hospital (the Women’s)
Summary
The Women’s Early Pregnancy Assessment Service (EPAS) is an outpatient clinic which assesses and manages women experiencing pain and/or bleeding in early pregnancy.
Women diagnosed with a miscarriage through the EPAS can opt to receive no treatment and let the miscarriage occur naturally or choose surgical or medical treatment. Surgical management involves removal of the pregnancy tissue through a minor operation known as curette, while medical management involves taking medication in hospital to assist the miscarriage process.
About 100 women are admitted to the Women’s every year for the latter option, however, sometimes women have to wait for a hospital bed to become available, delaying treatment and inconveniencing the patient.
To address this, the Women’s developed a new option where women could safely self-administer medication at home to assist with miscarriage, reducing the need for unnecessary hospitalisation and giving women more choice and control over their own care.
Aims
- Provide an easily accessible pathway of care for women experiencing miscarriage which may be transferable to other Victorian health service providers
- Increase choice for women
- Improve access to care and reduce unnecessary hospitalisation
- Improve the experience of women experiencing pain and/or bleeding during early pregnancy
- Release inpatient beds and resources for alternate use
- Formalise clinical follow-up processes and provide clinical support and monitoring for women undertaking medical management of miscarriage by establishing a nurse-run telephone clinic
Outcomes
- Enabled 74 women who opted for the new pathway of care to manage their miscarriage with medication at home, freeing up hospital beds and resources for other patients during the 12-month project period
- Gave women more choice and more control over their miscarriage treatment, allowing them to take the medication at their convenience
- Reduced the length of time women had to wait between diagnosis and active treatment from a baseline of waiting 48 hours (for inpatient admission) to two hours (as medication was prescribed and dispensed at the patient consult/diagnosis)
- Provided support to 98 per cent of patients on the home management pathway through the newly established, EPAS nurse-led telephone clinic
- Received positive feedback from patients, with 100 per cent of survey respondents saying they were well supported by the hospital and 83 per cent of those who underwent medical management of miscarriage at home saying they would select the pathway of care again
Update
December 2017 – The Women’s continues to offer the medical management of miscarriage at home pathway as an option for women experiencing early pregnancy loss. The management option has been embedded as ‘business as usual’ and will continue long term. The nurse-led telephone clinic has also been sustained and will continue to support the new home-based pathway of care.