Manual uterine aspiration use the emergency department for early pregnancy loss: A mixed methods study to assess the current landscape

Awarded 2020
Complex Family Planning Fellowship Research
Stephanie Grube, MD
Johns Hopkins University

Manual uterine aspiration is a safe management option for early pregnancy loss that can be used inside the emergency department (ED). Manual uterine aspiration use can reduce cost and decrease patient time in the ED. Despite these advantages, manual uterine aspiration has been underused and the reasons for this underuse are not known.
The primary objective of this study is to describe the barriers and facilitators to using manual uterine aspiration in the ED for management of early pregnancy loss (EPL). Secondary objectives of the study include to investigate the perceptions of manual uterine aspiration use in the ED, to understand the current patterns of manual uterine aspiration use and non-use in the US, and to use Geographic Information Systems (GIS) to map the geographic distribution of manual uterine aspiration use and non-use in EDs. To accomplish this, we will use the American Hospital Association (AHA) Annual Survey Database identify all EDs in the US, and department characteristics such as patient volume, religious affiliation, and the urban-rural classification of the facility. We will compare the population from the database to our sample to assess the representatives of our sample and to obtain the previously listed department characteristics from responding facilities. We will also use the AHA database information to inform purposive sampling in deficient regions. We will compare the effect of the presence of a Kenneth J. Ryan Residency Training Program on the likelihood of providing manual uterine aspiration at academic centers.
We plan a mixed methods study that will consist of two parts. First, we will distribute a web-based, national survey to ED stakeholders (ED physicians, nurses, advanced practice providers, and administrators) through email and outreach methods including recruitment at national conferences and mailed invitations to the online survey. Second, we will recruit a stratified sampling of respondents from the web-based survey to participate in subsequent in-depth interviews. These interviews will explore the details of the barriers that inhibit manual uterine aspiration use, and facilitators that allow the procedure to be offered in their ED.
Data analysis for the web-based survey will consist of descriptive statistics of manual uterine aspiration use patterns and associated characteristics of EDs; we will also compare the responses among different stakeholders in the ED and between facilities that use and do not use manual uterine aspiration. We will code the interviews for key themes around barriers and facilitators to manual uterine aspiration provision in the ED.
This will be the first nationwide study to obtain information regarding the prevalence of manual uterine aspiration use in the ED as well as barriers and facilitators to this practice. The results of this study can inform future initiatives that aim to improve access to manual uterine aspiration.