A lack of obstetricians, gynecologists and emergency departments in hospitals make it difficult to accept emergency patients for obstetrics and gynecology (OBGY), and has recently become a serious social problem. The primary contributing factor is that emergencies are not sorted according to severity. To improve primary emergency care, for OBGY in particular, we will here analyze the patients who have visited Chibune General Hospital's emergency department in the recent past. From January to December 2008, 2913 OBGY patients visited the emergency department. Of those patients, 66.3% (1932 patients) were first-time patients with no introduction documentation from other institutions, 22.9% (667 patients) were our clients, and 10.8% (314 patients) were transferred from other institutions, including maternal transfers.The total number of all patients who arrived to Chibune hospital by ambulance was 1920. However, only 17.8% (519) OBGY emergency patients needed admission. Most walk-in patients visited from 20:00 to 0:00 and these patients decreased from 0:00 to 8:00. However, the numbers of ambulance transfers were not effected throughout these time periods.
Moreover, we researched the reason for consultations, the number of admissions, and operations of first-visit cases, including patients introduced from other institutions. For the most part, in maternal transfer cases, there was a threat of premature labor.The major reasons for patients to be transferred from another institution other than maternal transfers were ectopic pregnancy and ovarian tumors. On the other hand abortion, dysmenorrhea, and pelvic inflammatory disease were major factors for first-visits without introduction documentation from other institutions. In half of all OBGY emergence cases, these patients were transferred by ambulance, but most patients went home without admission. Most consultations were tentative and appeared to be so-called “convenient store” visits. This is an indication that these patients probably do not have a primary care physician. This also leads to another difficulty in which severe cases needing emergency operations, or high-risk pregnancies had no prior OBGY data to consult. As a result of these emergency cases, and increasingly difficult working conditions, physician's duties are getting heavier and more stressful. This can be directly linked to a decrease in the number of OBGY doctors and therefore leads to the reduction of maternal neonatal medical institutions. In order to prevent what could become a very slippery slope, doctors have an obligation to educate patients about the use of ambulances and must reevaluate the problem of emergency OBGY cases, and thus contributing to achieve a proper system for the sake of medicine and patients. [Adv Obstet Gynecol,62(4):321-326, 2010(H22.11)]
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