Abstract
BackgroundIn recent years, an increasing number of states have enacted laws that impose specific requirements for facilities in which abortions are performed. In this study, we sought to understand the processes used to develop facility standards in the context of other, less politically charged areas of health care and consider implications for the context of abortion.MethodsWe conducted key informant interviews with 20 clinicians and accreditation professionals involved in facility standards development for common outpatient procedures (endoscopy, gynecology, oral surgery, plastic surgery). We examined the motivations for and processes used in facility standards development, use of scientific evidence in standards development, and decision-making in the absence of evidence. Interview data were thematically coded and analyzed using an iterative approach.ResultsIn contrast to U.S. state laws that target abortion facilities, standards for other outpatient procedures are commonly set by committees of clinicians organized by professional associations or accreditation organizations. These committees seek to establish standards that ensure patient safety without placing unnecessary burden on clinicians in practice. They aim to create evidence-based standards but can be hampered by lack of relevant research. In the absence of research evidence, committees rely on their clinical expertise and sense of best practices in decision-making. According to respondents, considerations of potential harm (e.g., deeper levels of sedation, invasiveness), rather than the specific procedure, should prompt additional requirements.ConclusionsIf facility standards in the context of abortion were developed through processes similar to other outpatient procedures, 1) professionals who perform the procedure would be involved in standards development and 2) in the absence of clear research evidence, the expertise of clinicians, and the guidelines and standards of other organizations, are used to describe a best practice standard of care.
Highlights
In recent years, an increasing number of states have enacted laws that impose specific requirements for facilities in which abortions are performed
We identify lessons learned from less politicized areas of medicine that may be applicable to abortion, if professional associations or accrediting organizations were to develop facility standards through a process in line with how similar entities have done this work
We identified respondents based on their known involvement in patient safety committees of professional associations or standards development committees of accreditation organizations and contacted them by email, phone and/or fax
Summary
An increasing number of states have enacted laws that impose specific requirements for facilities in which abortions are performed. An increasing number of states have enacted laws that impose specific requirements for facilities in which abortions are performed [4]. These are commonly referred to as TRAP laws, as they enact “targeted regulations of abortion providers” that do not affect other procedures or facilities. These laws are promoted as safeguarding women’s health, despite the lack of data indicating a patient safety problem and increasing evidence that such laws decrease women’s ability to obtain abortions [5,6,7]. Hellerstedt decision on the constitutionality of a Texas law requiring that abortions be performed in ambulatory surgery centers (ASCs) and by physicians with admitting privileges at a local hospital has been the most visible
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