Hospital utilization during or after abortion care: Incidents among patients of experienced and newly-trained providers in California

Introduction: Evidence shows abortion access can be expanded safely by offering services in primary-care settings and allowing provision by qualified nurse-practitioners, nurse-midwives, and physician assistants (NPs/NMs/PAs). However, in many US states, new regulations increasingly require that abortions be provided in ambulatory surgical centers or by physicians with local hospital admitting privileges, with the stated purpose of increasing patient safety. To understand whether early abortion care indeed requires access to tertiary facilities, we analyze hospital usage (visits, admission, and transport) among aspiration abortion patients. Methods: In an ongoing California study, patients receive abortion care from NPs/NMs/PAs and physicians, then are followed for four weeks. Incidents are monitored using an extensive tracking protocol and standardized methods for coding diagnoses, treatments, and outcomes. We identify rates and predictors of abortion-related complications and non-abortion-related system incidents following aspiration abortion. Results: Analysis will be completed in spring 2013. Based on 16,000 procedures at 22 facilities, the abortion-related complication rate is low (<2%). System incidents (e.g. hospital visits by patients without complications) are more common than major complications (involving hospital admission, transfusion or surgery). Conclusions: Most cases of patients' emergency-room usage are non-emergent, unrelated to abortion complications or provider type, and therefore classified as “system incidents” indicating suboptimal use of the appropriate levels of care facility. Assuming final results confirm low rates of cases requiring emergency treatment, safety concerns do not justify policies restricting early abortion care to surgical facilities or providers with admitting privileges. Findings are relevant for providers/administrators, advocates and policymakers considering similar requirements.