Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Ectopic pregnancy remains the leading cause of first-trimester maternal mortality. Delays in diagnosis and operative management increase morbidity and may be exacerbated by emergency department (ED) crowding. We evaluated whether integration of point-of-care ultrasound (POCUS) into the medical screening exam of pregnant patients—the obstetric medical screening exam—was associated with improved timeliness of care for patients with surgically managed ectopic pregnancy.

Methods: We conducted a single-center retrospective cohort study of adult patients undergoing operative management for ruptured ectopic pregnancy between January 1, 2019, and December 31, 2023, at a county safety-net hospital. The obstetric screening exam was implemented July 12, 2021, and incorporated focused transabdominal pelvic and right upper quadrant ultrasound into the initial ED evaluation, often prior to bed assignment. The primary outcome was time from ED arrival to operating room (OR). Secondary outcomes included time to obstetric consultation, time to hospital admission, ED length of stay (LOS), and POCUS use. Nonparametric testing was used for skewed time data. Logistic regression evaluated the odds of reaching the OR within four hours. Patient-level interrupted time series analysis assessed temporal trends.

Results: A total of 150 patients were included (87 pre- and 63 post-implementation). Median arrival-to-OR time decreased from 516 minutes (interquartile range [IQR] 324–709.5) to 391 minutes (IQR 220–619), a 125-minute reduction (P = .020; bootstrap 95% CI, 8–233). The proportion of patients reaching the OR within four hours increased from 16.1% to 31.8% (odds ratio 2.42; 95% CI, 1.11–5.29; P = .02). Time to obstetric consultation (210 vs 146 minutes; P = .003), time to hospital admission (345 vs 250 minutes; P = .005), and ED LOS (451 vs 367 minutes; P = .03) were all reduced. Point-of-care ultrasound use increased from 41.4% to 66.7% (P < .001), while the remainder underwent radiology ultrasound. Interrupted time series analysis demonstrated no significant immediate change after implementation (P = .790), but a significant postintervention trend toward reduced arrival-to-OR time (−0.45 minutes/day, P = .01).

Conclusion: Embedding POCUS into the medical screening examination in triage was associated with sustained improvement in operative timeliness for ruptured ectopic pregnancy. Early diagnostic integration within ED workflow may mitigate system-level delays in time-sensitive obstetric emergencies.