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.
Key words
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Article info
Publication history
Published online: October 20, 2016
Accepted:
October 11,
2016
Received in revised form:
October 3,
2016
Received:
July 11,
2016
Footnotes
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 2017;216:181.e1-7.
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Copyright
© 2016 Elsevier Inc. All rights reserved.
