Effect of a Quality Improvement Initiative on Procedural Abortion Pain and Anxiety Using a Standardized...

To evaluate the effect of a quality improvement initiative on procedural abortion pain and anxiety using a standardized patient-focused sedation options counseling guide.

We developed and implemented a patient-focused sedation options counseling guide for use across three reproductive health centers in Maine, New Hampshire, and Vermont. To evaluate the effect of the initiative, pain (0-10) and anxiety (0-5) scores were abstracted from the electronic health record for all patients who obtained procedural abortions with moderate sedation through 18 weeks of gestation (N = 362). A six-month pre/post implementation analysis was conducted examining pain and anxiety scores. To analyze differences in pain and anxiety while controlling for covariates, a hurdle model was fit with maximum intraoperative pain scores, and Poisson regression was fit with maximum full procedure anxiety scores as the outcomes of interest.

The proportion of patients reporting no pain increased from 13.0% to 22.7% with the use of the counseling guide (p = 0.03). The median maximum intraoperative pain score decreased from 5 to 4. In the unadjusted model, use of the counseling guide decreased the odds of patients reporting any intraoperative pain by 49% (odds ratio (OR): 0.51, 95% confidence interval (CI): 0.27-0.91). The odds ratio was similar after adjustment for covariates (OR: 0.52, 95% CI: 0.26-1.04). Use of the counseling guide showed no significant effect on anxiety.

We saw a reduction in procedural abortion pain after the implementation of the counseling guide. This adjunct to established pain management options is a simple improvement on current practice.