Online Program

Hospital utilization during or after abortion care: Incidents among patients of experienced and newly-trained providers in California

Tuesday, November 5, 2013 : 5:00 p.m. - 5:15 p.m.

Tracy A. Weitz, PhD, MPA, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, CA
Roula AbiSamra, MPH, Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco (UCSF), Oakland, CA
Sheila Desai, MPH, Dept. of Obstetrics and Gynecology and Reproductive Sciences, Advancing New Standards in Reproductive health (ANSIRH), Oakland, CA
Diana Taylor, RNP, PhD, Advancing New Standards in Reproductive Health, Bixby Center for Reproductive Health Research & Policy, Oakland, CA
E. Angel James, CNM, WHNP-C, MS, Department of Family Health, University of California, San Francisco School of Nursing, San Francisco, CA
Introduction: Evidence shows abortion access can be expanded safely by offering services in primary-care settings and allowing provision by qualified nurse-practitioners, nurse-midwives, and physician assistants (NPs/NMs/PAs). However, in many US states, new regulations increasingly require that abortions be provided in ambulatory surgical centers or by physicians with local hospital admitting privileges, with the stated purpose of increasing patient safety. To understand whether early abortion care indeed requires access to tertiary facilities, we analyze hospital usage (visits, admission, and transport) among aspiration abortion patients. Methods: In an ongoing California study, patients receive abortion care from NPs/NMs/PAs and physicians, then are followed for four weeks. Incidents are monitored using an extensive tracking protocol and standardized methods for coding diagnoses, treatments, and outcomes. We identify rates and predictors of abortion-related complications and non-abortion-related system incidents following aspiration abortion. Results: Analysis will be completed in spring 2013. Based on 16,000 procedures at 22 facilities, the abortion-related complication rate is low (<2%). System incidents (e.g. hospital visits by patients without complications) are more common than major complications (involving hospital admission, transfusion or surgery). Conclusions: Most cases of patients' emergency-room usage are non-emergent, unrelated to abortion complications or provider type, and therefore classified as “system incidents” indicating suboptimal use of the appropriate levels of care facility. Assuming final results confirm low rates of cases requiring emergency treatment, safety concerns do not justify policies restricting early abortion care to surgical facilities or providers with admitting privileges. Findings are relevant for providers/administrators, advocates and policymakers considering similar requirements.

Learning Areas:

Clinical medicine applied in public health
Planning of health education strategies, interventions, and programs
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe hospital usage after aspiration abortion in a multi-site California pilot project. Compare incidence of hospital visits, hospital admission, and hospital transport from the abortion facility, and explain how these categories differ. Describe types and rates of complications after aspiration abortion. Distinguish between abortion-related complications and system incidents, as well as immediate and delayed complications.

Keyword(s): Abortion, Emergency Department/Room

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have spent the last two years working with the project that collects these data and that developed the incident tracking and classification system employed here, and will be presenting material I researched.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.