Audit changes clinical practice! Impact on rate of justification of hysterectomy indication.

After performing a baseline audit in 1986-89, an ongoing quality assurance process was initiated in January, 1990 and all hysterectomies performed over the next 2 year period were analyzed. Hysterectomy indications were divided into two groups: one in which the uterine specimen was expected to show pathology and another in which no pathology was expected. The hysterectomy was considered justified in the former if the pathology report verified the indication or showed a significant alternate pathology. In the latter, validation criteria showing documentation of certain prerequisite diagnostic procedures performed before reverting to hysterectomy, were used to ascertain justification. The overall rate of justification in the ongoing audit was 96%, being 97% for the group where hysterectomy indication was potentially confirmable by pathologic study and 93% for the one where it was not. Comparison with baseline analysis showed that the justification rates were higher for all indications not potentially confirmable by pathologic study (93% vs 89%, p < 0.05), for recurrent uterine bleeding (90% vs 83%, p < 0.05) and for leiomyoma (97% vs 95%, p < 0.05). The improvement was associated with less frequent use of multiple indications in the ongoing study (10% vs 16%, p < 0.05). The justification rates for hysterectomy indication can be improved by prospective audit and by avoiding use of multiple indications.