Characterization of Postpartum Emergency Department Utilization Among a High-Risk, Urban Population [23L]. (May 2016)

• Record Type: Journal Article
• Authors: Guardado, Amanda; Sheen, Jean-Ju; Bernstein, Peter; Smith, Heather A.
• Is Part Of: Obstetrics and gynecology. Volume 127(2016)Supplement 1
• Publication Date: 2016-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000483432.31268.5c
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: Limited data exist regarding postpartum Emergency Department (ED) utilization among high-risk populations. We characterized clinical indications, patient characteristics, and ED resource utilization during the six weeks following delivery. METHODS: We abstracted demographic, psychosocial, and clinical variables from multiple sources on 100 consecutive postpartum patients presenting to the ED of a large urban medical center during 2012–2013. Primary outcome was time to ED presentation (Poisson regression), and secondary outcomes included multiple ED visits and hospital readmission (chi-square, logistic regression). RESULTS: Overall, 18% experienced multiple ED visits, and 44% were readmitted. Median time from discharge to ED presentation was 8 days—earlier for patients with obstetric-related complaints (5 vs 12 days, P =.004) and readmissions (5 vs 12 days, P =.003), but not different by delivery mode ( P =.15) or for patients with multiple visits ( P =.48). Frequent presenting indications included wound complications, hypertension/preeclampsia, abdominal pain, and neurologic symptoms, shifting towards non-obstetric indications for patients with multiple visits. Multivariate analysis revealed that pre-existing conditions were protective (OR 0.08, 95% CI 0.01–0.55), while psychiatric issues (OR 1.28, 95% CI 2.70–479.70) and labor-related complications (OR 7.31, 95% CI 1.17–45.57) were significantly associated with increased risk of multiple visits; significantly associated with readmission were labor-related complications (OR 3.26, 95% CI 1.07–9.96), NICU admission (OR 11.04, 95% CI 1.67–73.22), and time to presentation (OR 0.93, 95% CI 0.88–0.99). CONCLUSION: Multiple factors influencing postpartum ED utilization allow for opportunities for targeted interventions and systems-level changes to optimize postpartum care and emergent resource utilization, preventing unnecessary ED visits.