Evaluation of the Influence of Interdepartmental Training on Early Pregnancy Loss Management Practice Change

Abstract

Background: Treatment of early pregnancy loss (EPL) with expectant, medical or surgical management in the emergency department (ED) or in the outpatient clinic is safe, saves cost and time, and is preferred by some women. Nevertheless, surgical management in the operating room (OR) by an obstetrician/gynecologist (OB/GYN) remains conventional practice. The purpose of this study was to determine how an interdepartmental education and training intervention for EPL management affects the integration of comprehensive EPL management services within a large academic medical training institution. Methods: The Training Education and Advocacy in Miscarriage Management (TEAMM) project has provided interprofessional EPL management trainings over the past 8 years. In 2016, TEAMM began providing interdepartmental EPL trainings. In order to evaluate this new training approach, qualitative interviews were conducted with training attendees from 5 sites. Questions elicited information about participants’ perceptions regarding challenges facing their institution in integrating a full spectrum of EPL management services, ways it was beneficial to have both the OB/GYN and the emergency departments at the training and steps taken at their institution since the training to implement comprehensive EPL management. Interviews were audio recorded, transcribed and then coded with deductive and inductive coding to generate important themes reflected by the responses. Results: A total of 27 training attendees were interviewed. Perceived challenges to implementing full spectrum EPL management were: 1) lack of leadership buy-in, 2) unfamiliarity with manual uterine aspirations (MUAs), 3) institutional memory of a negative experience, 4) lack of systems and protocols, 5) discomfort associated with providing emotional support, and 6) ambiguity regarding the EPL/elective abortion relationship. The most significant positive outcomes of the training were: 1) increased understanding of MUAs, 2) increased understanding of the systems, roles and responsibilities surrounding EPL management, 3) acquisition of communication skills, and 4) clarification of the EPL/elective AB relationship. The majority of steps taken since the training towards the integration of comprehensive management of EPL were aimed at addressing the significant barrier of not having protocols supporting the provision of MUAs outside of the OR. Conclusions: The study results support the continuation of interdepartmental trainings as a means of helping with the implementation of EPL management outside of the OR. Having ED and the OB/GYN staff together to share perspectives and experiences was important to furthering the process of practice change. This study can be used as a resource for institutions wanting to bring a more patient centered approach to EPL management.