Table 3.

Recommendations

Recommendation	Mapped Themes	“Most Important”	“Quick Wins”
General Pregnancy & Pre‐Pregnancy Care & Information	Barriers	Raise awareness of EPAUs among women of reproductive age, perhaps through a national social media campaign and inclusion in the school curriculum	Provide women with the information they need when they leave the EPAU dependent on their outcome (e.g. amount and duration of bleeding and pain for natural miscarriage and medical miscarriage at home; how long to wait before trying to conceive again, and preconception advice for subsequent healthy pregnancies)
Accessibility of Early Pregnancy Assessment Units	Barriers	Provide suitable opening times, including weekends and evening and ensure alternative care providers for when EPAU is closed	Ensure appointments are not blocked on referral, apart from required checks for appropriateness of attendance Ensure accessible parking for women with early pregnancy complications
Staffing	Efficiency	Ensure EPAUs are appropriately staffed, both in number and skill mix Allocate appropriate appointment times and explain length of and reasons for any delays	Offer women a smooth process through EPAU by passing notes between EPAU staff to prevent re‐explaining symptoms
Within EPAU Experience	Staff Attitudes or Approach	Keep women informed, for example with information on the walls describing the process in the EPAU and that the person doing the scan may not speak while they are working. Be aware that every pregnancy, regardless of gestation, is important to that woman and do not attempt to minimise the loss
Managing Patients Sensitively	Sensitive Patient Management	Provide a distinct, but integrated EPAU service, by physically separating EPAUs from other hospital services, where possible, but having good cross healthcare links for ongoing care	Emphasise to staff the sensitivity of the nature of EPAU visits and ensure they act accordingly. For example, confirm it is the patient on phone before announcing they are EPAU, reception staff to cancel appointments after a loss without question and prevent routine recruitment, i.e. for flu vaccination taking place in EPAU waiting area Ensure privacy, for example by allowing women to fill out forms rather than verbally state their symptoms and ensuring that consultation rooms are not overheard by providing background noise and a private location
Communicating and Decision Making	Communication & Information Involvement in Care Decisions	Prepare women for the journey ahead of them by providing the information they need to understand and make decisions about what happens when discharged from the EPAU; be that when they go home – whether pregnancy is ongoing or not, or if they are heading to theatre for surgery, onto a ward or to a specialist for medical attention	Provide clear and accessible information that is specific to the condition a woman has and/or procedures they will have Involve women in their care decisions by providing women with the choice of the full range of options, appropriate to their condition and respect their choices if still clinically safe Involve a woman's partner in the processes and procedure, should women want them to be
Continuity of Care	Continuity of Care Sensitive Patient Management	Provide appropriate aftercare by developing new or improving links with psychological support services, in the NHS and/or other support organisations, for women after using EPAU services, giving women information on how to access these services and providing sufficient capacity for timely care. Explain to women the availability of follow‐up with GP, Community Midwife, EPAU or other specialists as appropriate Review referral and discharge processes to ensure a smooth transition into and out of EPAUs to make sure whoever is taking over care after discharge from EPAU is fully informed of women's notes from EPAU	Ensure there is efficient communication between EPAU and rest of maternity and/or hospital care, and community care by sending notes promptly and electronically from EPAU to healthcare providers who will next provide care for women