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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1047 — 2011 VHA Emergency Services for Women (ESW) Survey

Cordasco KM, Greater Los Angeles Healthcare System; HSR&D COE for the Study of Health Care Provider Behavior; Zephyrin LC, Women Veterans Health Strategic Health Care Group; Kessler CS, Jesse Brown VA Hospital; Mallard M, Women Veterans Health Strategic Health Care Group; Canelo IRubenstein LV, and Yano EM, Greater Los Angeles Healthcare System; HSR&D COE for the Study of Health Care Provider Behavior;

Objectives:
More women are using VHA Emergency Departments (EDs), but there are no national guidelines on capabilities required for providing safe, appropriate ED care to women. In a research-operations partnership, we surveyed VHA ED capabilities (resources and processes of care) relevant to caring for women Veterans.

Methods:
We surveyed all 120 VHA ED directors between May 24 and June 30, 2011. We report here primarily on results for gynecology and mental health consultation and for pregnancy testing. We compared female-specific capabilities to male-specific or gender-neutral capabilities to ground our analyses. We also assessed capabilities stratified by number of ED encounters by women, total ED encounters per year, facility complexity, and facility location in large versus small or non-metropolitan areas.

Results:
All VHA EDs (100%) completed the survey. Thirty-five percent of EDs have emergent gynecology consultations available at all times compared to 77% having cardiology and 74% urology. Emergency mental health consultation for sexual assault is available in 86% of EDs at all times, and 77% are able to arrange follow-up mental health services within 48 hours for this problem. EDs commonly use point-of-care testing (i.e., immediate testing in the ED) for troponin (58%) but not for pregnancy (8%). Other basic female-specific resources, such as speculums and gynecologic examination tables, are available in most, but not all EDs. EDs with fewer encounters by women, located in small or non-metropolitan areas, and part of less complex healthcare systems have lower capabilities for caring for women.

Implications:
While many VHA EDs have capabilities for female-specific care, substantial gaps remain, especially in those with fewer women Veteran encounters. Lack of point-of-care capability to carry out pregnancy tests, for example, may pose risks related to gynecologic emergencies or radiology testing. Such gaps must be further assessed and addressed if VHA is to provide high quality comprehensive care to women.

Impacts:
These data will be used as the basis for developing recommendations regarding appropriate capabilities for care for women in VHA EDs.


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