Women with early pregnancy bleeding experience care variations. We developed a guideline based on best available evidence to guide Emergency Department (ED) management.

To identify the barriers and enablers to the use of an evidence-based guideline for initial management of women with early pregnancy bleeding in the ED.

A mixed methods survey was distributed to 476 staff from four EDs and one Urgent Care Centre, across a health district. Quantitative data were analysed using jamovi (version 2.3.28) and qualitative data were coded and grouped into subcategories and categories. Enablers and barriers were identified, and quantitative and qualitative results were integrated.

One hundred and four staff completed the survey (response rate 21.8%). Two barriers to evidence-based practice were identified: knowledge and training gap; and ED resources and workload. Two enablers: ED clinician belief about appropriateness of care; and women are willing to stay, wait and/or request care. Two functioned as both enablers and barriers: guideline is available, however elements are absent or not applicable; and ED clinicians are confident in some but not all aspects of care.

Multiple enablers and barriers were identified that may affect the implementation of evidence-based practice for the management of early pregnancy bleeding.

Emergency department

Nursing

Implementation

Early pregnancy bleeding

Evidence-based care

© 2025 The Author(s). Published by Elsevier Ltd.