Emergency Department Use by Postpartum Patients: Implications for an Accountable Care Organization

Abstract

Background: As part of Accountable Care Organization (ACO) planning, we tracked our obstetrical population to see how they utilize services and access care. One area of scrutiny was emergency department (ED) use after delivery.

Methods: Patients who delivered at Jersey Shore University Medical Center (JSUMC) were identified. Health Information Systems searched the database for ED visits within 6 weeks of the delivery date. Of those who appeared in the ED, data was collected about mode of delivery, reason for ED visit, and the number of days postpartum.

Results: Within the study period, there were 2,022 women who delivered and 154 (7.6%) presented to the ED during their postpartum course for a total of 187 ED visits. There were 1,285 vaginal deliveries (63.6%) and 737 (36.4%) cesarean deliveries. Of the 154 patients who presented to the ED, 100 (64.9%) women were delivered via cesarean and 54 (35.1%) had vaginal deliveries. Obstetrical complications accounted for 137 (73%) of the ED visits. Complications unrelated to pregnancy accounted for 50 (27%) of the ED visits. Eighty-three visits (44%) occurred during the first week postpartum.

Conclusions: Postpartum ED utilization rates may be used as a measure of both efficiency and safety of obstetrical practice. Participating obstetricians in the ACOs should design the clinical standards and quality measures to optimize care of pregnant patients so that safe vaginal delivery is promoted. Physicians who can safely lower their cesarean delivery rates, have low ED utilization, and low readmission rates should be rewarded and retained.




J Clin Gynecol Obstet. 2015;4(2):209-211
doi: http://dx.doi.org/10.14740/jcgo312w