Self pregnancy testing at triage: Ectopic can we reduce the delay to diagnosis?

Ms Lynn O’Neill1, Ms Mary McCarthy1, Dr  Wendy  Pollock1,2,3, Professor Sue McDonald1,2
1Mercy Health , Melbourne , Australia, 2La Trobe University, Bundoora, Australia, 3University of Melbourne, Parkville, Australia

Background: Women of reproductive age frequently present to the emergency department (ED) with symptoms of abdominal pain, vaginal bleeding, nausea, vomiting or dizziness, which may relate to an ectopic pregnancy, a potentially life threatening condition. If not acutely unwell, these symptoms would typically receive a lower triage score resulting in a long waiting time and possibly a delay of assessment and diagnosis of an ectopic.
The Aim: To improve timelessness to treatment by early detection of pregnancy at triage with a reallocation of a higher triage category, through the introduction of urine self-testing using an instream pregnancy test (IPT).
Method: In July 2017, the IPT was introduced at triage of a metropolitan ED to women of reproductive age (13-50 years) presenting with abdominal pain, vaginal bleeding, nausea, vomiting or dizziness. An education programme, procedure and modification of the triage screen to support the documentation were implemented. A positive IPT would result in a higher triage category thus reducing the wait for assessment and diagnosis.
Results: In September 2017, a retrospective spot audit of 58 records found only six (10%) women had an instream at triage. By the April 2018 audit of 185 presentations, 52% (n=97) had documented an IPT at triage. Of these only 38% (n= 72) had the results documented in the medical record. One IPT performed identified a positive pregnancy test and a higher triage score assigned. One serious adverse event related to an ectopic pregnancy occurred in a woman who was not asked to perform an IPT at triage.
Discussion: Substantial ongoing effort was required to prompt the triage nurse to offer IPT. Various support strategies included persistent reinforcement through individual and group education, feedback and monitoring of compliance and strong leadership from the Nurse Unit Manager
Conclusion: Embedding IPT into routine triage process is challenging and requires multiple strategies to change clinical practice but offers the opportunity to avoid potential adverse outcomes

Lynn O’Neill, Registered Nurse of 35years with a Graduate Certificate in Emergency Nursing and a Batchelor of Education. Currently working in the Werribee Mercy Emergency Department as the Nurse Unit Manager for the past 12 years. A passionate nurse with an interest in improving clinical practice within emergency nursing