A structure and process evaluation of an Early Pregnancy Assessment Clinic (EPAC) in one Australian Emergency Department: Part 1

Abstract

Background Women experiencing complications associated with early pregnancy often present to the Emergency Department (ED). An Early Pregnancy Assessment Clinic (EPAC) was implemented in one Australian ED to specifically address acute needs of women with complications of early pregnancy. Methods This mixed methods study incorporated two parts: Part 1 utilised content analysis of semi-structured interviews conducted with health care professionals and EPAC women to evaluate the EPAC structures and processes. Part 2 was an observational study describing characteristics and temporal trends of women presenting to an ED with problems of early pregnancy over a 6-year period. Findings from Part 1 are presented in this paper; results from Part 2 are presented in an ensuing paper. Findings EPAC structures included the utilisation of a private environment situated within the ED as well as primary care management and delivery from a nurse who had ED experience and advanced pregnancy related knowledge. EPAC processes included appropriate referral and good communication. These processes enabled the delivery of a service between a variety of healthcare providers located within the hospital and community. Conclusions The multi-disciplinary, nurse-led, ED based EPAC model of care implemented facilitated continuity of care for a subset of ED patients. It may be useful in EDs elsewhere.