Early pregnancy loss (EPL) is defined as a nonviable, intrauterine pregnancy prior to 13 weeks of gestation. In the United States, there are about 1 million EPLs per year. In the ED setting, treating EPL can be challenging. ED physicians normally recommend Obstetrics and Gynecology (Ob/Gyn) outpatient or inpatient consult often leading to a delay between the diagnosis of EPL and the necessary counseling and/or initiation of treatment options. This delay is consistent with findings that those who present to the ED have a significantly longer time to resolution of EPL of 11 days, compared to 8 days for those who present to an ambulatory setting. It may also provide context for qualitative findings that patients who present to the ED for EPL are more likely to report a lack of clarity of diagnosis and inefficient care compared to those who present to an ambulatory setting.
We are proposing to conduct a pre-implementation study where we will conduct semi-structured interviews with a diverse group of EPL stakeholders. We will interview ED department administrators, clinicians and staff regarding their perspectives of surgical and medical management of EPL, examine patient experiences with EPL in the ED, and explore the feasibility of expanding treatment options in an urban safety net ED. Understanding all of the above could potentially expedite treatment for those who present to the ED with EPL and improve patient experience, as well as inform implementation strategies for EPL management expansion that could be potentially used in different contexts.