Development of System of Care for Ectopic Pregnancies, Buriram Hospital, Buriram Province

Abstract

This study aimed to develop a system of care for ectopic pregnancies. Action research with control chart was proposed to focus on women with ectopic pregnancy admitted to Buriram Hospital from 2010 to 2012. Purposive sampling technique was used to recruit the subjects. Draft system of care for ectopic pregnancies was developed, field-tested, and evaluated. Data were analyzed by frequency, percentage, content analysis, result analysis and process analysis. Control charts were used to assess the variability of blood consumption and average time spent in admitting until arrival at the operative room for both fast track and conventional track groups. It was found that delay in diagnosis and treatment from 2010 to 2012 was observed at 33.3%, 7.0%, and 4.6%, respectively. The average time spent from admission until arrival at the operating room in the fast track group was 60 mins, 50 mins and 34 mins with fast track compliance for hypovolemic shock rate of 90.9%, 93.7% and 90.0%, respectively. Death rate from ectopic pregnancy in 2010 was 2.2%; and no death reported in 2011 and 2012. Improper referrals from community hospitals were 28.0% in 2010, 6.0% in 2011, but none in 2012. The use of control charts to compare the care system in 2010-2012 revealed that there was a difference in average time spent from admission until arrival at the operative room between the fast track and the conventional groups. The newly developed system of care was clearly able to shorten the time wasted in the process of diagnosis and treatment. Previous history of blood consumption can be used to shorten the preparation time in blood transfusion process. The authors concluded that the new system of care for ectopic pregnancies was useful and could be used as a guideline to take care of the women with ectopic pregnancy. The new process enhances the importance of effective recording and reporting systems. Community hospitals were able to use the same system of care as Buriram Hospital, which in turn would promote collaboration among interdisciplinary team and networking for the care of ectopic pregnancies.