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Admitting privileges and hospital-based care after presenting for abortion: A retrospective case series.

ABSTRACT: OBJECTIVE:To examine the pathways of care for abortion patients transferred or referred to emergency departments (EDs) or hospitals before and after abortion-providing physicians obtained hospital admitting privileges. DATA SOURCES:This case series was based on retrospective chart review at three abortion clinics in which physicians had obtained admitting privileges in the previous 5 years. STUDY DESIGN:We identified patients who were transferred or referred to a hospital or ED. Patients were grouped according to the pathway by which their care was transferred or referred to the ED/hospital. PRINCIPAL FINDINGS:Both before and after admitting privileges, the majority of patients were referred to a hospital before the abortion was attempted and most were for suspected ectopic pregnancy or to perform the abortion in a hospital. Direct ambulance transfer from the facility to the ED/hospital was the least common pathway. We observed few changes in practice from before to after admitting privileges. Preexisting mechanisms of coordination and communication facilitated care that was tailored for the specific patient. CONCLUSIONS:We did not find evidence that physician admitting privileges influenced the pathways through which abortion patients obtain hospital-based care, as existing mechanisms of collaboration between hospitals and abortion facilities allowed for management of patients who sought hospital-based care.

SUBMITTER: Upadhyay UD

PROVIDER: S-EPMC6407355 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Admitting privileges and hospital-based care after presenting for abortion: A retrospective case series.

Upadhyay Ushma D UD Cartwright Alice F AF Goyal Vinita V Belusa Elise E Roberts Sarah C M SCM

Health services research 20181113 2

<h4>Objective</h4>To examine the pathways of care for abortion patients transferred or referred to emergency departments (EDs) or hospitals before and after abortion-providing physicians obtained hospital admitting privileges.<h4>Data sources</h4>This case series was based on retrospective chart review at three abortion clinics in which physicians had obtained admitting privileges in the previous 5 years.<h4>Study design</h4>We identified patients who were transferred or referred to a hospital o ...[more]

PMID: 30423207

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Project description:BackgroundTo evaluate the ophthalmic manifestations and radiographic features of ectopic orbital meningioma to improve diagnostic accuracy.MethodsPatient data from patients admitted to our institution during a 217-month period from August 1999 to September 2017 were included. Patient ophthalmic manifestations, radiographic features (CT and MRI), diagnosis, pathology, therapeutic regimens, and prognosis were retrospectively reviewed.ResultsSix patients with ectopic orbital meningioma were identified. The mean age at the first visit was 33.2 years (range, 7-56 years). All six patients displayed manifestations of exophthalmos, upper eyelid oedema, and motility impairment with a mean history of illness of 20.3 months (range 3-72 months). Optical lesions were located in the superonasal extraconal compartment (3/6, 50%), bitemporal extraconal compartment (1/6, 16.7%) and orbital intraconal compartment (2/6, 33%). Radiographic features were ill-defined, heterogeneous, enhancing soft tissue masses with extraocular muscular adhesion (6/6, 100%) and calcification (1/6, 16.7%), not adjacent to the optic nerve and not extending along the dura. Six cases were treated intraoperatively with complete surgical resection, indicating that all lesions were independent of the optic nerve and sphenoid ridge. The histopathologic classification was mostly of meningothelial cells (5/6, 83%). Immunohistochemistry revealed EMA and vimentin to have positive expression in all six cases, while two cases were calponin-positive and strongly expressed in the olfactory bulb. Postoperatively, lesions caused no visual impairment, and there were no cases of recurrence.ConclusionsEctopic orbital meningiomas are rare tumours that are not easily diagnosed without postoperative histopathology. This report highlights some of the distinguishing features of isolated orbital lesions, especially around the location of frontoethmoidal suture. Accompanying upper eyelid oedema and eye mobility restriction were observed to be dissimilar to other orbital tumours. In these cases, a diagnosis of ectopic orbital meningioma should be considered.

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Admitting privileges and hospital-based care after presenting for abortion: A retrospective case series.

Publications

Admitting privileges and hospital-based care after presenting for abortion: A retrospective case series.

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