Impact of a standardised decision-making tool on the identification of abortion-seeking patients at risk of ectopic pregnancy: A human factors approach

IF 3.1 2区 工程技术 Q2 ENGINEERING, INDUSTRIAL Applied Ergonomics Pub Date : 2024-12-20 DOI:10.1016/j.apergo.2024.104428
Stephen Franklin , Patricia A. Lohr , Patrick Waterson
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Abstract

Ectopic pregnancies are uncommon among women presenting for abortion. However, where suspected, rapid referral for definitive diagnosis is essential to prevent harm.
We assessed whether implementation of a standardised decision-making tool, an algorithmic representation of the clinical decisions and associated actions defined in policy, in a British abortion service was associated with a reduction in missed opportunities to escalate care where indicated.
We compared two cohorts: pre-implementation 01/03/2018-28/02/2019 (n = 2191) and post-implementation 01/08/2019-29/02/2020 (n = 1837). Implementation was associated with improved management: Escalation post-implementation was significantly higher in cases with uncertain menstrual dating (12.8% vs 8.9%), gestation by last menstrual period over 5 weeks (86.9% vs. 23.0%), prior tubal surgery (0.9% vs. 0.3%), and pain (54.1% vs. 44.5%). Missed escalation of care was lower post-intervention than pre-intervention (0.33 % vs. 1.14%, respectively, p = 0.004). Escalation resulting in an ectopic pregnancy diagnosis occurred more often post-implementation [n = 129 (7.0%)] than pre-implementation [n = 116 (5.3%)], p = 0.03.
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一个标准化的决策工具对识别有异位妊娠风险的寻求堕胎的患者的影响:人为因素方法。
异位妊娠在堕胎妇女中并不常见。然而,一旦怀疑,迅速转诊进行明确诊断对于防止伤害至关重要。我们评估了在英国堕胎服务中实施标准化决策工具(临床决策和政策中定义的相关行动的算法表示)是否与减少错过的机会有关。我们比较了两个队列:实施前2018年3月1日至2019年2月28日(n = 2191)和实施后2019年8月1日至2020年2月29日(n = 1837)。实施与改善管理相关:在月经日期不确定(12.8% vs 8.9%)、最后一次月经超过5周的妊娠(86.9% vs 23.0%)、既往输卵管手术(0.9% vs 0.3%)和疼痛(54.1% vs 44.5%)的病例中,实施后的升级率明显更高。干预后错过的护理升级比干预前低(分别为0.33%比1.14%,p = 0.004)。妊娠升级导致异位妊娠诊断在实施后[n = 129(7.0%)]较实施前[n = 116(5.3%)]发生率高,p = 0.03。
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来源期刊
Applied Ergonomics
Applied Ergonomics 工程技术-工程:工业
CiteScore
7.50
自引率
9.40%
发文量
248
审稿时长
53 days
期刊介绍: Applied Ergonomics is aimed at ergonomists and all those interested in applying ergonomics/human factors in the design, planning and management of technical and social systems at work or leisure. Readership is truly international with subscribers in over 50 countries. Professionals for whom Applied Ergonomics is of interest include: ergonomists, designers, industrial engineers, health and safety specialists, systems engineers, design engineers, organizational psychologists, occupational health specialists and human-computer interaction specialists.
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