Obstetrics and Gynecology, Boston University/Boston Medical Center, Boston, MA, United States.
Obstetrics and Gynecology, Boston Medical Center, Boston, MA United States.
Contraception. 2023 Sep;125:110091. doi: 10.1016/j.contraception.2023.110091. Epub 2023 Jun 16.
A preimplementation study to examine the context of, and barriers and facilitators to, providing early pregnancy loss care in one emergency department (ED), to inform implementation strategies to improve ED-based early pregnancy loss care.
We recruited a purposive sample of participants and conducted semistructured individual qualitative interviews focused on caring for patients experiencing pregnancy loss in the ED until saturation was reached. For analysis, we used framework coding and directed content analysis.
Participant roles in the ED included administrators (N = 5), attending physicians (N = 5), resident physicians (N = 5), and registered nurses (N = 5). Most (70%, N = 14) participants identified as female. Primary themes included (1) caring for early pregnancy loss patients is challenging and uncomfortable, (2) inability to provide compassionate early pregnancy loss care causes moral injury, and (3) stigma influences early pregnancy loss care. Participants explained that early pregnancy loss is challenging due to added pressure, patient expectations, and gaps in knowledge. They reported barriers to providing compassionate care that are out of their control, such as systematic workflows, limited physical space, and insufficient time and expressed that these barriers lead to moral injury. Participants also reflected on how early pregnancy loss and abortion stigma affect patient care.
Caring for patients experiencing early pregnancy loss in the ED requires unique considerations. ED staff recognize this and desire more early pregnancy loss education, clearer early pregnancy loss tools and protocols, and early pregnancy loss-specific workflows. With concrete needs identified, an implementation plan to improve ED-based early pregnancy loss care can be created, which is important now more than ever, due to the impending influx in the ED for early pregnancy loss care after the Dobbs decision.
Since the Dobbs decision, patients are self-managing abortions and/or seeking out-of-state abortion care. Without access to follow-up, more patients are presenting to the ED with early pregnancy loss. By demonstrating the unique challenges emergency medicine clinicians face, this study can support initiatives to improve ED-based early pregnancy loss care.
在一家急诊科开展实施前研究，以了解提供早期妊娠丢失护理的背景、障碍和促进因素，为改善基于急诊科的早期妊娠丢失护理的实施策略提供信息。
我们招募了有目的的参与者样本，并进行了半结构化的个人定性访谈，重点是在急诊科照顾经历妊娠丢失的患者，直到达到饱和。在分析中，我们使用了框架编码和有针对性的内容分析。
急诊科参与者的角色包括管理人员（N=5）、主治医生（N=5）、住院医生（N=5）和注册护士（N=5）。大多数（70%，N=14）参与者为女性。主要主题包括（1）照顾早期妊娠丢失患者具有挑战性且令人不适，（2）无法提供富有同情心的早期妊娠丢失护理会造成道德伤害，以及（3）耻辱感会影响早期妊娠丢失护理。参与者解释说，早期妊娠丢失具有挑战性是因为增加了压力、患者的期望以及知识的差距。他们报告了一些超出他们控制范围的提供富有同情心的护理的障碍，例如系统工作流程、有限的物理空间、时间不足，并表示这些障碍导致了道德伤害。参与者还反思了早期妊娠丢失和堕胎耻辱感如何影响患者护理。
在急诊科照顾经历早期妊娠丢失的患者需要特殊考虑。急诊科工作人员认识到这一点，并希望获得更多的早期妊娠丢失教育、更清晰的早期妊娠丢失工具和方案，以及专门针对早期妊娠丢失的工作流程。明确了具体需求，就可以制定改善基于急诊科的早期妊娠丢失护理的实施计划，鉴于多布斯裁决后，ED 对早期妊娠丢失护理的需求增加，这一点现在比以往任何时候都更为重要。
自多布斯裁决以来，患者自行管理堕胎或寻求州外堕胎护理。由于无法获得后续护理，更多的患者因早期妊娠丢失而到 ED 就诊。通过展示急诊医学临床医生面临的独特挑战，本研究可以支持改善基于 ED 的早期妊娠丢失护理的倡议。
