A comparison of two models of gynecology service consultation to the emergency department in an academic medical center

Objective: This study was undertaken to determine differences in resource use and outcomes when emergency department (ED) physicians consult the gynecology service routinely versus selectively. Study Design: In July 2000, an ED policy of “routine” gynecology consultation for pregnant women less than 20 weeksʹ gestation with pain and/or bleeding complaints changed to a policy of “selective” consultation. Resource use and outcomes were compared for 222 women who received care during the 9 months before the protocol change with 268 women who presented during the 9 months after the protocol change. Results: With selective consultation, patients receiving gynecology evaluations decreased from 74% to 39%. Return visits to the ED increased from 9% to 21%. Ultrasound studies performed by ED physicians and radiologists increased, whereas studies by gynecologists decreased. Patients waited longer and received more unnecessary human chorionic gonadotropin studies. Conclusion: A policy of selective gynecology consultation, compared with routine gynecology consultation in the ED, increases diagnostic study resource use and patient length of stay. (Am J Obstet Gynecol 2003;188:1166-8.)