prov:vic:wh:gynae_epas_referral

Western Health early pregnancy assessment service (EPAS) referral process

introduction

  • The EPAS service is to provide expert advice and continuity of clinical care for women presenting with complications of early pregnancy.
  • EPAS is an ambulatory (outpatient) service for clinically stable patients.
  • The service is a combination of:
    • Dedicated EPAS clinic (now in JKWCH on Women’s Clinic ‘B’, on Level 1 - RN contact phone 53148)
    • EPAS registered nurses with specific expertise in the management of early pregnancy
    • 8 booked appointments for EPAS are available from 08:30 – 12:00 Monday to Friday (via iPM referrals from ED)
    • Between 12:30 - 17:00 Monday to Friday, a walk in service is available for women presenting to the Sunshine Hospital (SH) Emergency Department (ED) or the JKWC MAC
    • EPAS does not provide any service after hours, on weekends or on public holidays, these patients will be redirected to the ED.
    • EPAS RN shift is rostered from 08:30 – 17:00 Monday to Friday.
    • Nominated EPAS registrar 0800 – 1600 M-F (afternoons this is the EDOG registrar?) with on-call O&G consultant.
    • Dedicated sonographer/sonologist service with immediate reporting.
    • Clinical guidelines and algorithms to support care:
      • EPAS clinical practice guideline – NICE early pregnancy management
      • Algorithm for bleeding and pain in early pregnancy
      • Information for EPAS patient referred from ED
      • Pathways of Care for Early Pregnancy complications - flow sheet
    • Patient information for ED, inpatients and EPAS clinic attendances.

EPAS (from 6/3/17) will be a single site continuity of care model – clinical review, ultrasound, medical and surgical management and ongoing review by telephone. Discharge planning will include verbal and written communication to referring GP.

inclusion criteria

  • Pregnancy confirmed with urine or blood HCG that is complicated by pain or PV bleeding (or both)
  • Gestation less than or equal to 16 weeks’ (includes ultrasound diagnosed missed miscarriage)
  • Patient is clinically stable (not requiring parenteral analgesia and minimal PV loss).
  • Clinically stable confirmed or suspected Ectopic Pregnancy (EP) may be suitable for EPAS referral, but MUST be discussed with EPAS team or on-call O&G registrar.

If uncertain as to eligibility for EPAS, discuss with either EPAS RN, EPAS registrar (M-F) or on-call O&G.

exclusion criteria

  • >16 weeks - refer to MAC instead.
  • clinically unstable
    • intra-uterine pregnancy with ongoing moderate to heavy PV bleeding
    • suspected inevitable miscarriage with cervical shock
    • suspected or confirmed ectopic pregnancy with pain/hypotension/tachycardia etc.
    • demographic barriers to OP care (language/transport etc)
  • EPAS is NOT the referral point for gynaecology conditions such as ovarian/adnexal pathology or hyperemesis gravidarum.
  • Suspected fetal anomalies with outside scans and/or at-risk genetic screening results should be discussed with the MFM unit (foetal / fetal medicine)

How to make an EPAS appointment

  • EPAS appointments are made through iPM or via direct phone call to the EPAS RN Monday-Friday 0800-1600
  • The ED clerical staff will be trained in the iPM referral process
  • The EPAS RN will review the referrals received in the morning Monday-Friday and contact the patient
  • EPAS referrals approved after discussion or review by the O&G team are made in the same way through ED clerical staff.

ED Mx and documentation required

  • tests to order in ED:
    • FBE
    • Blood group and antibody screen if not known to be Rh +ve
    • Quantitative B-HCG if indicated
    • Pelvic ultrasound referral for EPAS team – on standard imaging request – “TA/TV pelvic ultrasound – early pregnancy”. Patient to bring this to the EPAS appointment.
  • Should Anti-D be administered in ED?
    • If the EPAS referral is going to be < 24 hrs, Anti-D can be deferred to the EPAS team.
    • If the interval from referral to appointment is > 24 hrs (Friday/Sat), Anti-D 250IU IMI should be administered to patients with Rh-ve blood group.
    • Sunday-Thursday presentations will be contacted by EPAS RN the next morning and Anti-D
  • provide patient information:
  • documentation:
    • Normal ED documentation in EDIS
    • EPAS clinic documentation is on a dedicated database (G+ - Solutions Plus) which interfaces with Bossnet to transfer a summary of each EPAS visit to the DMR.
prov/vic/wh/gynae_epas_referral.txt · Last modified: 2019/05/15 01:59 by wh