Implementing a community model of early pregnancy care

Abstract · Introduction · In the UK Early Pregnancy Assessment Units (EPAUs) are usually situated alongside hospital maternity and gynaecology services. In June 2018, the Oxford EPAU relocated from the John Radcliffe Hospital to a community clinic. This is to our knowledge, the UK’s first community-based EPAU. This change was inspired by our patient feedback describing the co-location of the EPAU with maternity services as distressing. · Methods · Following the introduction of the community EPAU we developed a database to capture information on the patients seen in the clinic. This is a retrospective observational study of a single cohort of patients attending the clinic over an 8 month period. Data was collected from 1 st July 2018 to 28 th February 2019. This data included clinical, safety and patient experience outcomes. · Results · 2920 patient episodes were recorded, 1932 were new patients. 72.2% were diagnosed as viable pregnancies, 389 miscarriages were diagnosed, of which 84.1% were incomplete/missed and 15.9% were complete. Once miscarriage was confirmed 48.6% chose conservative management, 19.9% chose medical management, and 31.5% chose surgical management. 25 ambulance transfers occurred due to ruptured ectopic, suspected ectopic, heavy bleeding, collapse, or ectopic with no personal transport. 32 unplanned admissions from patients seen in EPAU accounted for 2.7% of all patients seen in EPAU. 58 patients had ultrasonographically confirmed or suspected ectopic pregnancies- 3% of patients seen in clinic. Patient feedback questionnaires have been consistently positive. · Conclusion · The development of a community EPAU has improved services to allow care closer to home in an environment separate from maternity care. Our data shows that a community EPAU is safe, can deliver good patient care and is a service valued by patients. Further research is indicated to evaluate the cost-effectiveness of community EPAUs and the long term safety and effectiveness of care.