Early pregnancy assessment units: we must centre the patient experience to improve early pregnancy care

The article ‘Women's experiences of early pregnancy assessment unit services: a qualitative investigation’, presented by Hall et al. is an important examination of the patient perspective on early pregnancy assessment units (EPAU). The authors conducted qualitative interviews with people attending EPAUs for early pregnancy care to assess experiences. Based on the results, the authors compiled a series of patient-driven recommendations for improving EPAUs across the UK. As one of the first qualitative studies to centre the patient experience at EPAUs in a clear attempt to improve care, this was an important and needed study. Overall, Hall et al. found people seeking care at EPAUs were highly satisfied with the care received, but they identified several areas in need of improvement (Hall et al. BJOG 2021; 128:2116–2125). Similar to an earlier qualitative study focused on experiences at one EPAU (Norton et al. BMJ Open 2018;8:e023579), recommendations centred on availability of appointments, wait times, clear communication, privacy from other patients attending the centre and empathetic, sensitive care. In particular, clear communication around expected symptoms, next steps and possible outcomes as well as having the time for questions were singled out by patients as lacking. While many providers may find themselves short on time or empathy concerning bleeding or cramping in the first trimester, we must remember that for the patient this is an uncertain and anxiety-ridden time. Hall et al.’s qualitative work reminds us that centring the patient and their needs through clear explanations in simple language and leaving time for questions is of utmost importance. While specific to EPAUs in the UK, the patient-derived recommendations for improvement are universal and, if implemented, these changes will have a lasting effect on care delivery. Improving communication, increasing availability and refocusing on care delivery from a place of empathy are patient-centred endeavours that should be implemented. Further, routine involvement of patients in directing quality improvements and changes in EPAUs will ensure continued excellence in care. Although EPAUs have been established in the UK for over 30 years, international recognition of these units as centres for efficient, expert-guided care has increased in recent years. There have been calls for hospitals in the USA to implement these types of clinics in thoughtful, patient-centred ways (Shorter et al. Contraception 2021;104:128–31). Qualitative evidence such as that in Hall et al. and Norton et al. provides further bases for patient-driven implementation and improvement. Further, international guideline-based quality indicators for EPAUs were recently established and will be useful in any seeking to establish this type of care model (van den Berg et al. Reprod BioMedicine Online 2020;40:453–9). By centring the patient experience, EPAUs will be best equipped to provide timely, empathetic and highly satisfactory care. None declared. Completed disclosure of interests forms are available to view online as supporting information. Upon invitation to write a mini-commentary, Jennifer Kaiser conceived of and wrote the commentary. Not applicable. None. None. No original data were used in this paper. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.