Leung Stephanie, Leyland Nicholas, Murji Ally
Hamilton Health Sciences Centre, McMaster University, Hamilton ON.
Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON.
J Obstet Gynaecol Can. 2016 Apr;38(4):351-6. doi: 10.1016/j.jogc.2016.01.004. Epub 2016 Mar 5.
At our institution, diagnostic hysteroscopy (DH), often combined with uterine curettage, commonly has been performed in the main OR with the patient under general anaesthesia. Our objective was to create targeted interventions aimed at decreasing the number of DHs performed in the OR by 75% over one year.
This quality improvement initiative had a quasi-experimental (time-series) design. To obtain baseline numbers of DHs performed each month, we conducted a retrospective chart audit at a university teaching hospital. We implemented the following three groups of interventions: (1) staff education and case review, (2) accessible sonohysterography, and (3) an operative hysteroscopy education program. Procedures were tracked prospectively over a 12-month intervention period and an additional 12-month maintenance period.
One hundred eleven DHs were performed at baseline. During the intervention period, 33 DHs were performed, a 70% reduction from baseline. This resulted in related savings of $126 984 and 12.5 surgical days. In the final quarter of the intervention period, there was an 81% reduction in the number of DHs with adequate preoperative evaluation compared with baseline. Twenty DHs were performed in the maintenance period, an 82% reduction from baseline. The absolute number of complications from DH remained constant during the study period.
Carefully planned and targeted interventions to change the culture at our institution decreased the number of DHs performed in the main OR. These initiatives improved patient care, saved costs, and improved OR utilization. Long-term follow-up showed maintenance of the improvements in the year subsequent to the interventions.
在我们机构，诊断性宫腔镜检查（DH）通常与刮宫术联合进行，常在主手术室对全身麻醉下的患者实施。我们的目标是制定针对性干预措施，在一年内将手术室中进行的DH数量减少75%。
这项质量改进计划采用了准实验（时间序列）设计。为获取每月进行DH的基线数量，我们在一家大学教学医院进行了回顾性病历审核。我们实施了以下三组干预措施：（1）员工教育和病例审查，（2）可获得的超声宫腔镜检查，（3）宫腔镜手术教育计划。在为期12个月的干预期和额外的12个月维持期内对手术进行前瞻性跟踪。
基线时进行了111例DH。在干预期，进行了33例DH，比基线减少了70%。这带来了126984美元的相关节省以及12.5个手术日的节省。在干预期的最后一个季度，与基线相比，术前评估充分的DH数量减少了81%。维持期进行了20例DH，比基线减少了82%。在研究期间，DH的并发症绝对数量保持不变。
精心规划和有针对性的干预措施改变了我们机构的文化，减少了主手术室中进行的DH数量。这些举措改善了患者护理、节省了成本并提高了手术室利用率。长期随访显示，干预后的一年中改进得以维持。
