Decreased waiting periods in a public pregnancy termination clinic

Abstract

Background In our public hospital, first-trimester pregnancy termination historically had been performed in an operating room by suction curettage on a separate day following the initial clinic visit. To increase efficiency, we instituted three changes over a 2-year period: (a) pregnancy termination procedures were relocated to the outpatient area; (b) same-day service was initiated; and (c) manual vacuum aspiration was introduced. Our primary objective was to assess the effects of these changes on the waiting period in days from the intake visit to the day of termination procedure. Our secondary objectives included assessing any decrease in gestational age at the time of procedure, increases in the numbers of procedures at <9 weeks, the numbers of procedures per session and the proportion done on the day of intake. Methods This is a retrospective cross-sectional review of the clinical records of patients who requested pregnancy termination. Data were obtained on 625 patients who underwent a surgical termination of pregnancy from February 1, 2004, to January 31, 2006. Results The waiting period decreased from 20.3 to 3.6 days (p<.01), and mean gestational age at termination decreased from 11 to 9 weeks (p<.01). The proportion at <9 weeks' gestation increased from 1.7% to 40% (p<.01). The number of procedures per session increased by 52.7% (p<.01). The percentage of same-day procedures increased from 7% to 62%. Conclusion We improved efficiency of care by reducing the waiting period and terminating pregnancies earlier in gestation with manual equipment.