Who Returns? Factors Linked to Follow-Up After Emergency Department Visits for Pelvic Organ Prolapse

INTRODUCTION: While the ED remains an important interface with the healthcare network, follow-up rates after ED visits are low. In one study evaluating emergency department visits for pelvic organ prolapse, 84% of patients who presented with previously undiagnosed prolapse did not receive a referral to a urogynecologist. Determining the barriers to follow-up for these patients can allow for implementation of a systematic follow-up protocol. OBJECTIVE: The purpose of this study is to determine which factors are associated with follow-up in urogynecology clinic within 6 months of their presentation to the emergency department at a public safety-net hospital. METHODS: The study is a retrospective study of women aged 18–95 who presented to obstetrics and gynecology emergency services department at a public safety-net hospital and received a diagnosis of pelvic organ prolapse from January 2020 to December 2023. Demographics, history, physical exam, and follow-up data were abstracted from the medical record. Descriptive statistics and bivariate analyses were used to determine factors associated with follow-up. RESULTS: From January 2020 to December 2023, 293 women were seen for pelvic organ prolapse and received urogynecology clinic referrals. 33 patients followed up in urogynecology clinic within 1 month (11.2%), 58 followed up in urogynecology clinic within 2 months (19.8%), and 77 followed up within 3 months (26.3%). By 6 months, 180 patients of the 294 had followed up (61.4%). For those seen within six months, higher prolapse stage (p = 0.005), insurance status with county-based healthcare cost reduction program (p = 0.017), older age (p = 0.002), and higher BMI (p = 0.029) were statistically significant factors that predicted patient follow-up. Race, previous pelvic surgery, smoking status, employment status, and distance from home to hospital were not statistically significant in predicting follow-up. CONCLUSIONS: In this cohort, post-emergency department follow-up for pelvic organ prolapse was relatively high at 61.4%. Factors associated with higher follow-up rates (advanced prolapse stage, higher BMI, and older age) are also linked to greater healthcare utilization, suggesting these patients may be more familiar with the healthcare system. Notably, patients enrolled in a county-based healthcare reduction program were also more likely to follow up, highlighting the importance of reducing financial barriers. Together, these findings underscore the critical need to address both patient-level and system-level determinants of follow-up care to ensure timely management of pelvic organ prolapse.