Practice change following an interdepartmental training on early pregnancy loss management in the emergency department

AbstractEarly pregnancy loss (EPL), or miscarriage, is the most common complication of early pregnancy, and pregnant people experiencing EPL most often seek care from their primary obstetric provider or from an emergency department (ED). However, it is uncommon for providers outside obstetrician-gynecologists to be trained in EPL management, and nursing and support staff are also not often included. This study assessed change in practice following an interprofessional training intervention of self-reported use of manual uterine aspiration for management of EPL in the ED. We conducted a single arm pre-test/post-test interventional study design with a matched sample of pre- and post-test data from participants at 8 academic medical center sites that received a training intervention from the Training, Education & Advocacy in Miscarriage Management project between March 2016 and May 2017. We assessed the provision of EPL services in the ED and provider attitudes about these services. Our sample included 80 faculty physicians, resident physicians, and advanced practice clinicians from 8 academic medical center sites. Our findings demonstrate a positive association between participation in the training intervention and self-reported use of manual uterine aspirator in the ED for management of EPL, as well as increased belief that coordination between departments within the institution was smooth post-training. Our findings suggest that the training intervention was successful in influencing the practice of management of EPL using manual uterine aspiration in the ED, highlighting the importance of engaging EDs in training efforts.