Do emergency physicians save time when locating a live intrauterine pregnancy with bedside ultrasonography?

Objective: To determine whether patients presenting to the emergency department (ED) with first-trimester pregnancy complications have a decreased length of stay (LOS) when a live intrauterine pregnancy (IUP) is diagnosed by emergency physicians (EPs).

Methods: This study was performed at an urban community ED with a residency program and an annual census of 65,000. A retrospective chart review from October 1995 to August 1998 identified 1,419 patients who received ultrasound examinations confirming live IUP in the first trimester with pain and/or bleeding. Two hundred seventy-seven of these patients received their ultrasound examinations from EPs; 1, 142 patients received a study from radiology and were not scanned by EPs. The LOSs for the two groups were compared and defined as the time from being placed into a room to discharge from the ED. Significance was determined using a two-tailed t-test. Median times with confidence intervals were calculated.

Results: When patients had a live IUP confirmed by an EP, the median LOS was 21% (59 min) less than those who received an ultrasound examination by radiology (p = 0.0001; 95% CI = 49 min to 1 hr 17 min). When evaluated by time of day, patients who presented after hours (6 PM to 6 AM) and were scanned by EPs spent 28% (1 hr 17 min) less time in the ED (p = 0.0001; 95% CI = 55 min to 1 hr 37 min).

Conclusions: Emergency physicians identifying live IUP with bedside ultrasonography significantly decreased patients' LOSs in the ED. The decrease in LOS was most apparent for patients presenting during evening and nighttime hours.