# Quality Improvement Project for the Management of per Vaginal (PV) Bleeding in Early Pregnancy: Evaluating the Effectiveness of Patient Information Leaflets

## TL;DR

This study shows that providing better information and education to healthcare staff significantly improves communication with patients experiencing early pregnancy bleeding.

## Contribution

The study demonstrates the effectiveness of low-cost interventions in improving compliance with communication standards in emergency care for early pregnancy bleeding.

## Key findings

- Leaflet provision improved from 19% to 81% after interventions.
- Verbal explanation rates increased from 25% to 75% following staff education.
- Confirmation of understanding rose from 25% to 80% with targeted improvements.

## Abstract

Vaginal bleeding in early pregnancy is a frequent cause of emergency department (ED) visits, often associated with significant anxiety. Effective communication and the provision of written information are considered fundamental to patient-centred care and are consistently emphasised across clinical guidelines and best-practice recommendations. This study aimed to assess compliance with national and local standards for communication and information provision to women presenting with per vaginal (PV) bleeding in early pregnancy. A two-cycle retrospective audit was conducted in the ED of a district general hospital in Yorkshire, England. Case notes of women presenting with PV bleeding (≤16 weeks’ gestation) between March and June 2025 were reviewed. Standards assessed included provision of patient information leaflets (PILs), verbal explanations, and confirmation of understanding. Following the first audit, interventions included staff education, improved leaflet accessibility, and visual reminders. A re-audit was conducted three months later using identical criteria. A total of 217 patients were reviewed (119 in the first audit, 98 in the second). Leaflet provision improved from 19% to 81% (p < 0.001), verbal explanation from 25% to 75% (p < 0.001), and confirmation of understanding from 25% to 80% (p < 0.001). All showed strong effect sizes (Cramer’s V 0.51-0.60).

Targeted education and improved leaflet access significantly enhanced compliance with communication standards. Simple, low-cost interventions can substantially improve patient understanding, satisfaction, and adherence to national guidelines in the management of early pregnancy bleeding.