Delivering quality care: What can emergency gynaecology learn from acute obstetrics? O. H. Bika 1 & L. C. Edozien 2 1 Rotherham NHS Foundation Trust, Rotherham and 2 Manchester Academic Health Science Centre, University of Manchester, St Mary’s Hospital, Manchester, UK Correspondence: L. C. Edozien, Manchester Academic Health Science Centre, University of Manchester, St Mary’ s Hospital, Manchester M13 9WL, UK. E-mail: leroy.edozien@manchester.ac.uk Organisational standards Until about a decade ago, the management of gynaecological emergencies did not command attention as an area in need of specialised or dedicated arrangements. Te initial management of acute gynaecology cases was ofen done in the Accident and Emergency (A&E) department, out of hours, and by minimally- supervised training grade doctors. In the 1990s, the concept of an Early Pregnancy Assessments Unit (EPAU) was introduced (Bigrigg and Read 1991) and soon became a standard com- ponent of gynaecological services in the UK, but EPAUs dealt solely with early pregnancy problems, as it was felt that women ‘who are not pregnant are better managed elsewhere’ (Edey et al. 2007). Refecting the growing need for acute services in gynaecology, their remit gradually expanded to include other gynaecological emergencies (Table II), and their nomencla- ture was correspondingly changed to Emergency Gynaecology Units (EGUs) (Jones and Pearce 2009). Te need for this change was illustrated by an audit in one hospital, which showed that 61% of emergency gynaecological referrals were for pregnancy- related complications but 39% were non-pregnancy-related (Bain 2006). Generally, acute obstetric care in contemporary UK practice is delivered by well organised, cost-efective and efcient units, which prioritise patient safety and satisfaction. Tis was not always the case, as the labour ward in UK hospitals was run almost entirely by registrars and midwives, with no dedicated consultant labour ward sessions, and consultant input was gen- erally limited to a ward round and telephone advice. A quan- tum leap was taken with the publication and implementation of organisational and clinical standards for the delivery suite (RCOG and RCM 1999). Similar standards have recently been recommended for emergency gynaecology (Farquharson and Overton 2011). In contrast to emergency gynaecology units, acute obstetric units are readily accessible by patients and supported by senior staf and facilities, including ready access to an operating theatre. Both the efciency of the obstetric unit and patient experience have been enhanced by the introduction of a triage facility which afords better management of patient fow and optimal deploy- ment of resources. Acute obstetric care has also been enhanced by coordination and communication between the community midwife, the GP and the triage unit. Journal of Obstetrics and Gynaecology, 2014; Early Online: 1–4 © 2014 Informa UK, Ltd. ISSN 0144-3615 print/ISSN 1364-6893 online DOI: 10.3109/01443615.2014.902041 Emergency obstetric care in the UK has been systematically developed over the years to high quality standards. More recently, advances have been made in the organisation and delivery of care for women presenting with acute gynaecological problems, but a lot remains to be done, and emergency gynaecology has a lot to learn from the evolution of its sister special interest area: acute obstetric care. This paper highlights areas such as consultant presence, risk management, patient fow pathways, out-of-hours care, clinical guidelines and protocols, education and training and facilities, where lessons from obstetrics are transferrable to emergency gynaecology. Keywords: Acute obstetrics, emergency gynaecology, general gynaecology, quality Introduction Te UK National Institute for Health and Clinical Excellence (NICE) published guidelines for the management of early preg- nancy problems and called for better organisation of care for women with these problems (NICE 2012). Arguably, however, the gaps in service delivery identifed by NICE apply not just to early pregnancy problems but to all emergency gynaecological care. Acute obstetric care in the UK has been systematically devel- oped over the years to relatively high quality standards. Emer- gency gynaecology, on the other hand, is only just emerging as an area of special interest. With its expansion, rising expecta- tions on the part of patients and advances in technology, there is a largely unmet need for organisational change in order to meet quality and safety goals. Te provision of gynaecologi- cal emergency services in the UK and elsewhere, varies from unit to unit, from well-established ultrasound-based services in some units to patchy services in others. On the whole, however, emergency gynaecology has a lot to learn from the evolution of its sister special interest area: acute obstetric care. Tis paper highlights areas, such as clinical leadership, risk management, patient fow pathways, out-of-hours care, clinical guidelines and protocols, education and training and facilities – where les- sons from obstetrics are potentially transferable to emergency gynaecology (Table I). J Obstet Gynaecol Downloaded from informahealthcare.com by 86.184.59.121 on 04/12/14 For personal use only.