Quality statement 1: Timely referral to early pregnancy assessment services

Quality statement

Women referred to early pregnancy assessment services are seen by the service at least within 24 hours of referral.

Rationale

Women with a suspected ectopic pregnancy or miscarriage should be referred to an early pregnancy assessment service for diagnosis and management based on an initial clinical assessment. Women should always be seen within 24 hours of referral. However, depending on the clinical assessment, some women may need to be seen immediately to avoid adverse incidents, such as the rupture of a fallopian tube in an ectopic pregnancy. In addition, some women should be referred directly to an accident and emergency department, for example if they are haemodynamically unstable. It is important that appropriate measures are put in place to ensure the safety of the woman.

Quality measures

Structure

Evidence of local arrangements to ensure that women referred to early pregnancy assessment services are seen by the service at least within 24 hours of referral.

Data source: Local data collection.

Process

Proportion of women referred to early pregnancy assessment services who are seen by the service at least within 24 hours of referral.

Numerator – the number in the denominator who are seen in early pregnancy assessment services at least within 24 hours of referral.

Denominator – the number of women referred to early pregnancy assessment.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (secondary care services) ensure that a system is in place to enable women referred to early pregnancy assessment services to be seen by the service at least within 24 hours of referral.

Healthcare professionals (such as consultant obstetricians, gynaecologists and ultrasonographers) see women in an early pregnancy assessment service at least within 24 hours of referral.

Commissioners (clinical commissioning groups for secondary care) ensure that early pregnancy assessment services are able to see women at least within 24 hours of referral. They may also work with NHS England area teams to raise awareness and ensure clear that protocols and referral pathways are in place.

Women who are referred to a hospital early pregnancy assessment service are seen within 24 hours of referral. They may be referred by a healthcare professional (for example, their GP, midwife or nurse, or an emergency department doctor) or, if they have had an ectopic pregnancy in the past, or 3 or more miscarriages, they should be able to book an appointment themselves.

Source guidance

Ectopic pregnancy and miscarriage: diagnosis and initial management (2019) NICE guideline NG126, recommendation 1.2.4

Definitions of terms used in this quality statement

Early pregnancy assessment services

An early pregnancy assessment service can be located in a dedicated early pregnancy assessment unit or within a hospital gynaecology ward. All early pregnancy assessment services should:

  • be a dedicated service provided by healthcare professionals competent to diagnose and care for women with pain and/or bleeding in early pregnancy and

  • offer transvaginal ultrasound and assessment of serum human chorionic gonadotrophin (hCG) levels and

  • be staffed by healthcare professionals with training in sensitive communication and breaking bad news. [Adapted from NICE's guideline on ectopic pregnancy and miscarriage, recommendation 1.2.2]

Referral

Women can be referred by a healthcare professional (such as a GP, emergency department doctor, midwife or nurse) who has made a clinical decision about whether the woman should be seen immediately or within 24 hours of the referral. [NICE's guideline on ectopic pregnancy and miscarriage, recommendations 1.2.3 and 1.3.11]

Women who have had recurrent miscarriage (the loss of 3 or more pregnancies before 24 weeks of gestation) or a previous ectopic pregnancy can self‑refer to an early pregnancy assessment service. [NICE's guideline on ectopic pregnancy and miscarriage, recommendation 1.2.3]

Equality and diversity considerations

Appropriate care may depend on the ability of a woman to access services quickly, which may be difficult for some groups of women, such as women who are recent migrants, asylum seekers, refugees, or women who have difficulty reading or speaking English. It is important to ensure that services are easily accessible to women from these groups.