IS A MISCARRIAGE AN EMERGENCY? A QUALITATIVE STUDY ASSESSING EMERGENCY MEDICINE PHYSICIANS’ VIEWS TOWARD APPROPRIATE CARE FOR EARLY PREGNANCY LOSS IN THE EMERGENCY DEPARTMENT

Abstract

Objectives

Patients experiencing early pregnancy loss (EPL) commonly seek care in the emergency department (ED) and often report negative experiences. This qualitative study explores how emergency medicine (EM) physicians view EPL management in the emergency department.

Methods

We interviewed 22 EM physicians regarding their treatment of EPL in the ED; we included EM physicians in diverse practice settings, including states with and without abortion restrictions. Semi-structured interviews assessed participants’ current EPL diagnosis and management practices, their attitudes toward what EPL care should be provided in the ED, with attention to the impact of abortion restrictions and differing practice settings. Qualitative data were coded and analyzed for themes.

Results

Most participants reported commonly encountering EPL, though being limited by lack of access to ultrasound diagnosis. Most considered communicating EPL diagnoses as within EM’s scope of practice, but felt discomfort in counseling about management, citing lack of education and uncertainty around which options obstetrician gynecologists (Ob-Gyns) would offer. Most participants only felt comfortable providing expectant management without Ob-Gyn involvement. Time, space, lack of training, scope of practice, and medical-legal concerns were cited as barriers to providing medication and procedural treatment. Many believe EPL management could be improved in the ED but acknowledge competing acuity and lack of education as barriers. Abortion restrictions rarely affected participants' views on miscarriage management, but impacted their ability to provide appropriate care.

Conclusions

EPL is a common ED complaint, but care varies significantly based on practice setting. Standardization and collaboration between Ob-Gyns and EM may improve care for patients experiencing EPL in the ED.