Specialist nurse supported discharge in gynaecology: a randomised comparison and economic evaluation.
OBJECTIVE
To determine the effect on quality of life and cost effectiveness of specialist nurse early supported discharge for women undergoing major abdominal and/or pelvic surgery for benign gynaecological disease compared with routine care.


METHODS
Randomised controlled trial comparing specialist nurse supported discharge with routine hospital care in gynaecology. The SF-36, a generic health status questionnaire, was used to measure women's evaluation of their health state before surgery and at 6 weeks after surgery. A further questionnaire scoring patient symptoms, milestones of recovery, information given and satisfaction, was administered prior to discharge from hospital and at 6 weeks thereafter.


METHODS
Gynaecology service at the Western Infirmary Glasgow, part of North Glasgow University, NHS Trust.


METHODS
One hundred and eleven women scheduled for major abdominal or pelvic surgery for benign gynaecological disease.


METHODS
SF-36 health survey questionnaire baseline scores were reported before surgery and at 6 weeks follow-up. Complications, length of hospital stay, readmission, information on discharge support and satisfaction of women were recorded at discharge from hospital and at 6 weeks follow-up. A cost consequence analysis was conducted based on the perspective of the NHS.


RESULTS
The addition of a specialist nurse to routine hospital care in gynaecology significantly reduced the post-operative length of hospital stay p = 0.001, improved information delivery and satisfaction of women. The specialist nurse supported discharge group was associated with significantly lower total costs to the NHS than routine care resulting principally from the difference in the cost of the post-operative length of stay.


CONCLUSIONS
Women undergoing major abdominal and pelvic surgery were discharged home earlier with provision of support from a specialist gynaecology nurse. The results of this study suggest that duration of hospital stay can be shortened by the introduction of a specialist nurse without introducing any adverse physical and psychological effects. This process of care is associated with receipt of information on health and lifestyle issues and maintenance of high levels of patient satisfaction and demonstrates the effectiveness of the specialist nurse role in the provision of health information for women. Earlier hospital discharge at 48 h after major abdominal and pelvic surgery is an acceptable, cost effective alternative to current routine practice in the absence of further randomised evidence.
Obstetrics and Gynaecology Directorate, Princess Royal Maternity, North Glasgow University Hospitals NHS Trust, United Kingdom. Heather.Dawes@northglasgow.scot.nhs.uk
Heather A
HA
Dawes
Teresa
T
Docherty
Isabel
I
Traynor
David H
DH
Gilmore
Alan G
AG
Jardine
Robin
R
Knill-Jones
D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000191:economics / Q000534:rehabilitation*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008875:Middle Aged; D009720:Nurse Clinicians; D010351:Patient Discharge / Q000191:economics; D017060:Patient Satisfaction; D020127:Recovery of Function; D012606:Scotland