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Aust N Z J Obstet Gynaecol. 2013 Feb;53(1):46-50. doi: 10.1111/ajo.12025. Epub 2012 Dec 6.

Barriers to the 4-h rule: what causes delays for gynaecology patients in the emergency department?

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  • 1Department of Obstetrics and Gynaecology, Joondalup Health Campus, Joondalup, Western Australia, Australia.

Abstract

OBJECTIVES:

To explore factors that led to noncompliance with the 4-h rule for gynaecology patients in a general emergency department.

METHODS:

A cross-sectional cohort study was performed at a general emergency department. The files of all female patients aged from birth to 100 years presenting from 1 January 2009 to 31 December 2010 were screened. Those patient's files where a coded gynaecological diagnosis was made were reviewed. A time flow analysis was then undertaken of 580 consecutive files to evaluate barriers to admission or discharge of patients within the 4-h period. A further 300 files were audited to determine whether suboptimal management by emergency department staff contributed towards delays.

RESULTS:

There were 134 438 presentations to the emergency department, of which 2968 were gynaecology presentations (2.2%). The overall compliance with the 4-h rule was 66%. Patients with acute triage status, who were pregnant or who were eventually admitted, were more likely to be managed in compliance with the 4-h rule. The main barriers to compliance were incomplete examinations by emergency department staff; waiting for ultrasound examinations and blood test results; delays waiting for specialty review; and delays caused by initial review by surgical teams.

CONCLUSION:

Specific barriers to compliance with the 4-h rule can be identified in gynaecology patients. Strategies specific to overcome these barriers can be developed to improve compliance.

PMID:
23216452
DOI:
10.1111/ajo.12025
[PubMed - indexed for MEDLINE]
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