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

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.