Admitting privileges and hospital-based care after presenting for abortion: A retrospective case series

Abstract

Objective: To examine the pathways of care for abortion patients transferred or referred to emergency departments (EDs) or hospitals before and after abortion-providing physicians obtained hospital admitting privileges.

Data sources: This case series was based on retrospective chart review at three abortion clinics in which physicians had obtained admitting privileges in the previous 5 years.

Study design: We identified patients who were transferred or referred to a hospital or ED. Patients were grouped according to the pathway by which their care was transferred or referred to the ED/hospital.

Principal findings: Both before and after admitting privileges, the majority of patients were referred to a hospital before the abortion was attempted and most were for suspected ectopic pregnancy or to perform the abortion in a hospital. Direct ambulance transfer from the facility to the ED/hospital was the least common pathway. We observed few changes in practice from before to after admitting privileges. Preexisting mechanisms of coordination and communication facilitated care that was tailored for the specific patient.

Conclusions: We did not find evidence that physician admitting privileges influenced the pathways through which abortion patients obtain hospital-based care, as existing mechanisms of collaboration between hospitals and abortion facilities allowed for management of patients who sought hospital-based care.

Keywords: United States; abortion; admitting privileges; emergency department; hospital.

Figure 1

STROBE diagram: Facilities screened for eligibility

Figure 2

Timing of data collection, by pre vs postadmitting privileges [Color figure can be viewed at http://www.wileyonlinelibrary.com/] Notes: Facility 2 did not open until early 2013; Facility 3 closed for reasons unrelated to admitting privileges in late 2015.