Gynecologists in the VA: do they enhance availability of sex-specific services and policies in the emergency department?

Gray KE, Katon JG, Callegari LS, Cordasco KM, Zephyrin LC. Gynecologists in the VA: do they enhance availability of sex-specific services and policies in the emergency department? Medical care. 2015 Apr 1; 53(4 Suppl 1):S76-80.

Related HSR&D Project(s)

• CDA 14-412 – Reproductive Planning for Women Veterans

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Abstract:

OBJECTIVES: To examine the association between on-site gynecology and availability of sex-specific services and policies in Department of Veterans Affairs (VA) emergency departments (EDs). RESEARCH DESIGN: Cross-sectional analysis using data from a VA national inventory of emergency services for women and gynecologist staffing information from the VA Office of Productivity, Efficiency, and Staffing. SUBJECTS: ED directors from all VA medical centers (N = 120). MEASURES: We used logistic regression to evaluate the association between on-site gynecologist full-time equivalents (FTEs, < 0.5 and 0.5), and availability of sex-specific ED services, such as consult and follow-up within VA by a gynecologist, emergency contraception, rho (D) immunoglobulin, pelvic ultrasound, and transfer policies for obstetric and gynecologic emergencies. All analyses were adjusted for number of ED encounters by women. RESULTS: Greater gynecologist FTE ( 0.5 vs. < 0.5) was associated with increased odds of on-site availability of a gynecology consultation in the ED [odds ratio (OR) = 10.9; 95% confidence interval (CI): 3.2, 36.6] and gynecologist follow-up within VA after an ED encounter (OR = 2.5; 95% CI: 1.0, 6.2). A positive trend was seen in availability of rho (D) immunoglobulin (OR = 1.4; 95% CI: 0.6, 3.5) and presence of transfer policies for obstetric (OR = 1.7; 95% CI: 0.7, 4.5) and gynecologic emergencies (OR = 1.6; 95% CI: 0.6, 4.2). Half of the facilities with < 0.5 FTE did not have transfer policies in place or under development. CONCLUSIONS: On-site gynecologist FTE is associated with improved availability of sex-specific care in EDs. Development of transfer processes for obstetric and gynecologic emergencies in settings with limited on-site gynecology is needed.