Nanaimo Obstetrics and Gynecology physician, Dr. Regina Renner provides care to women who experience early pregnancy loss (EPL). During these traumatic events, many women go to the emergency department and then must wait an average of 26 hours before undergoing a uterine aspiration in the operating room. The wait time, multiple hospital visits and uncertainty contribute to the emotional and logistical burden of a stressful medical emergency. One woman surveyed said, “the wait time and not knowing when the procedure was going to happen was extremely difficult and I felt very alone.”
Dr. Renner wanted to change the system to improve the patient experience and physician experience when treating EPL - that’s why she joined the Physician Quality Improvement Initiative.
The Physician Quality Improvement program is a collaboration between Doctors of BC, the Ministry of Health and Island Health. Interested physicians sign-up for one year of quality improvement workshops and lead a quality improvement project. These projects are varied - cohort two projects range from improving early psychosis treatment to streamlining the referral process for MAiD.
Dr. Renner led her project team, including the Nanaimo Regional General Hospital (NRGH) Emergency Department, Obstetrics and Gynecology surgeons and the PQI team on the PDSA cycle to Plan, Do, Study and Act a small test of change – offer uterine aspirations in the emergency department under intravenous sedation (provided by the Proceduralist Service) and local anesthesia.
Dr. Renner’s background review and survey showed that 80 women per year undergo a uterine aspiration for EPL at NRGH. The average wait time from operating room booking to procedure time is 26 hours, and although 94% of women survey are satisfied with their care, only 64% are satisfied with the wait times. Preliminary cost analysis showed that performing the uterine aspiration in the emergency department is significantly less expensive than in the operating room.
In order to reduce wait times and provide women with uterine aspirations in the emergency department, optimizing emergency department staff resources and education are needed and under way.