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

Objective: To determine whether patients presenting to the emergency depart ment (ED) with first-trimester pregnancy complications have a decreased len gth of stay (LOS) when a live intrauterine pregnancy (IUP) is diagnosed by emergency physicians (EPs). Methods: This study was performed at an urban c ommunity ED with a residency program and an annual census of 65,000. A retr ospective chart review from October 1995 to August 1998 identified 1,419 pa tients who received ultrasound examinations confirming live IUP in the firs t trimester with pain and/or bleeding. Two hundred seventy-seven of these p atients received their ultrasound examinations from EPs; 1,142 patients rec eived 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 r oom to discharge from the ED. Significance was determined using a two-taile d 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. T he decrease in LOS was most apparent for patients presenting during evening and nighttime hours.