Abstract
Study Objective
We sought to improve emergency care for adolescents with abnormal uterine bleeding
(AUB) by developing a clinical effectiveness guideline (CEG) and assessing its effect
on quality of care.
Design, Setting, Participants, and Interventions
A stakeholder engagement group designed a CEG algorithm for emergency AUB management.
Pediatric residents received CEG training and their knowledge and attitudes were assessed
using pre- and post intervention surveys. International Classification of Diseases
ninth and 10th revision codes identified electronic health record data for patients
who presented to the pediatric emergency department for AUB 6 months before and after
CEG implementation. A weighted, 20-point scoring system consisting of prioritized
aspects of history, laboratory studies, and management was developed to quantify the
quality of care provided.
Main Outcome Measures
Descriptive statistics, χ2 test, Wilcoxon rank sum test, and a run chart were used for analysis.
Results
Pediatric residents reported higher confidence and knowledge scores post CEG implementation.
Of the 91 patients identified, 62 met inclusion criteria. Median score was 14 ± 7
before CEG implementation and 15.5 ± 6 after. The Wilcoxon rank sum test showed a
difference in AUB evaluation and management scores (P = .09) after implementation of the CEG. Run chart data showed no shifts or trends
(overall median score, 14 points). Pre- and post implementation, points were deducted
most frequently for not assessing personal/family clotting disorder history. The largest
improvements in care were with appropriate medication dosing and disposition.
Conclusion
We designed a CEG and educational intervention for AUB management in a pediatric emergency
department. These findings suggest our CEG might be an effective tool to improve emergency
AUB care for adolescents and could increase trainees’ confidence in managing this
condition, although additional cycles are needed.
Key Words
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Article info
Publication history
Published online: November 16, 2018
Footnotes
The authors indicate no conflicts of interest.
Identification
Copyright
© 2018 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
