Impact of a standardised decision-making tool on the identification of abortion-seeking patients at risk of ectopic pregnancy: A human factors approach.

Abstract

Ectopic pregnancies are uncommon among women presenting for abortion. However, where suspected, rapid referral for definitive diagnosis is essential to prevent harm. We assessed whether implementation of a standardised decision-making tool, an algorithmic representation of the clinical decisions and associated actions defined in policy, in a British abortion service was associated with a reduction in missed opportunities to escalate care where indicated. We compared two cohorts: pre-implementation 01/03/2018-28/02/2019 (n = 2191) and post-implementation 01/08/2019-29/02/2020 (n = 1837). Implementation was associated with improved management: Escalation post-implementation was significantly higher in cases with uncertain menstrual dating (12.8% vs 8.9%), gestation by last menstrual period over 5 weeks (86.9% vs. 23.0%), prior tubal surgery (0.9% vs. 0.3%), and pain (54.1% vs. 44.5%). Missed escalation of care was lower post-intervention than pre-intervention (0.33 % vs. 1.14%, respectively, p = 0.004). Escalation resulting in an ectopic pregnancy diagnosis occurred more often post-implementation [n = 129 (7.0%)] than pre-implementation [n = 116 (5.3%)], p = 0.03.