Used to monitor pregnancy of unknown location, ectopic, and molar pregnancies. Once a person has an IUP, resolve the episode. Reference email from Susan with how-to documents.
Adding patient to the Beta Book:
- •Find episodes of care in the upper right hand corner of EPIC (or search it).
- •Create a new episode.
- •Name: PUL
- •Type: Ectopic / Molar Pregnancy
Setting up follow-up:
- •New encounter → internal communication to 1J triage → “Please schedule a beta MD appointment in 2 days. She has been added to the beta book.”
- •Order beta (STAT). Reason: pregnancy of unknown location.
Managing the Beta Book:
- •Search “My Reports” in Epic within the Duke Clinic Gynecology context.
- •Search “beta” under Library → click “DUHS Betabook Has Active Episode” — brings in everyone with an active Ectopic / Molar episode to review.
- •Favorite this report so you can find it more quickly.
Do Beta Book twice a week:
- •If not already done, write a 1-liner about the patient.
- •Put newest data at the top (like Cervix Clinic results).
- •If following molar pregnancy: “downtrending beta in setting of mole, following to zero” + most recent beta.
- •Partial mole: follow to <5, then HCG q1 month <5 before can resolve.
- •Complete mole: follow to <5, then HCG q1 month for 3 months at <5 before can resolve.
- •If have gestational sac with a yolk sac, resolve Episode of Care (following until IUP, not until viability).
- •Day of missed appointment, send internal communication to 1J Triage to call patient for scheduling. Click Priority before sending. Title: “Beta book follow up attempt #”. (Easier when screening to see if patient needs certified letter sent.)
- •A week later, send another internal communication to call patient.
- •Third contact, ask to call again and send certified letter → close Beta Book encounter.
- •Don’t resolve Episode of Care until nurse confirms letter sent.
Pro Tips:
- •If following at DWHA or OSH, can resolve episode if another provider is performing PUL care (evidenced by completed visit).
- •If patient is scheduled directly by ED for PUL follow-up, make sure there is STAT beta ordered.
- •For younger patients with molar pregnancies, consider calling directly to counsel on importance of follow-up.
- •Tell patient someone from our team will contact them, and if not, to reach out to the 1J numbers (.1javs).
Susan’s 3-strike rule for Beta Book contact:
- •1st time (first 2–5 days of initial encounter): document as internal communication what the patient needs (beta vs beta/MD), forward to 1J triage RN. Order the beta MD as STAT. Highlight the priority in the routing. You should receive closed-loop communication from the triage nurse when this is completed.
- •2nd time (within 1–2 weeks of initial encounter): same as above. Consider referral to Duke Well to try to have them contact patient and assess various barriers to care.
- •3rd time (after 3 weeks of initial encounter): forward internal communication to 1J triage nurses and ask them to issue a certified letter to the patient regarding the need for an urgent appointment. Remove them from the Beta Book.