Protocol for evaluation of the continuum of primary care in the case of a miscarriage in the emergency room: a mixed-method study

Abstract

BackgroundIn Quebec (Canada), nearly 20,000 pregnancies end in miscarriage, and the majority of the miscarriages are dealt with in an emergency unit. Although there are studies documenting the effects of this type of grief on mental health, men’s experiences are much less discussed than those of women. Similarly, no study has evaluated best practices in terms of service continuity, from emergency care to community resources. The aim of this study is to better understand the relationships that exist between the organization of emergency room and primary care health services for women presenting with miscarriage, on the one hand, and the positions and experiences of women and men within these services, on the other.MethodsThe general objective of this mixed-method study can be broken down into three methodological sections. Focus 1. Institutional discourses and practices. This section is structured as a multiple case study of the mandates of five participant institutions. The study will involve (a) a documentary analysis; (b) a quantitative survey (N: 200) and (c) group interviews (N: 75) with caregivers and emergency unit managers. Focus 2. Women’s and men’s experiences of miscarriages and the institutional response. This section includes (a) a survey (N: 232) and (b) individual interviews (N: 80) designed to identify best practices in emergency involving women and their partners in each area. Focus 3. This section will integrate the information furnished by the first two sections in order to create an ethnographic overview of the situation.DiscussionThis innovative project will provide answers to critical questions on how to improve the effectiveness and quality of interdisciplinary and multisectoral interventions to promote the mental health and psychosocial well-being of couples having experienced a miscarriage. It will have a material effect on the organization of emergency services and of the primary care pathway for women experiencing a miscarriage and for their partners.Trial registrationNot applicable. This study involves a retrospective view of usual health care interventions. This study is not a clinical trial that prospectively assigns human participants or groups of humans to one or more health-related interventions to evaluate the effects on health outcomes.

Suspected Miscarriage in the Experience of Emergency Medical Services Teams—Preliminary Study

“…Pregnancy loss and its impact, mainly on the psychological health of women, represents a major challenge for the public health sector and health care professionals providing care to patients in this exceptional time [ 7 , 15 ]. In addition, patients experiencing symptoms that can potentially indicate a threat to the pregnancy may seek assistance by various means: reporting to a clinic or a hospital emergency department, or placing an emergency call [ 1 , 4 , 9 , 10 , 13 ]. These aspects motivated us to investigate the characteristics of EMS team interventions in cases of suspected miscarriage, or pregnancy loss up to the 22nd gestational week.…”

“…Research demonstrates that women who had lost a pregnancy may experience sadness, shame, or guilt, in addition to symptoms of depression, grief, or anxiety, which may be transient or persist for a number of years. All of the above factors may affect the woman’s health or the course of subsequent pregnancies [ 6 , 7 , 8 , 9 ].…”

“…As vaginal bleeding and abdominal pain are symptoms indicative of a threat to pregnancy, they prompt women to seek assistance from health care professionals, including via hospital emergency departments [ 1 , 7 , 9 , 10 ]. Importantly, these and other alarming symptoms may occur at any time during pregnancy and constitute a threat both to the woman’s health and life [ 11 , 12 ].…”

La urgencia bajo la lupa: una revisión de la producción científica sobre servicios de emergencia en hospitales desde la etnografía

“…The approach to issues that can improve quality of care refers to variations or improvement in the circuits of care in the emergency department, oriented towards increasing efficiency 57,58 or supervision of tasks on the ward that would have an impact on both patient and staff safety 59 . Concerning specific emergency services such as the obstetrics department 60 , additional proposals include the use of patient identification bracelets 61 and person-centered care 62 . Studies also approach the ward classification system as a decision-making tool in emergency services 63 .…”