title: The effect of preoperative checklists on final histology and rates of hysterectomy for benign conditions.
abstract: OBJECTIVE
  Our null hypothesis was that the introduction of preoperative hysterectomy checklists for fibroids, dysfunctional uterine bleeding (DUB), and chronic pelvic pain (CPP) would not affect the rate of hysterectomy or the proportion of cases with nonconfirmable final pathology.
  
  
  METHODS
  Using a prospective 6-month cohort, we compared the rate of hysterectomy (using ambulatory current procedural terminology codes for all eligible patients) and the preoperative diagnoses to final histologic diagnoses, to a baseline 6-month retrospective cohort. We also sought to determine the proportion of completed preoperative checklists among eligible cases.
  
  
  RESULTS
  Checklist implementation was associated with a significant decrease in the hysterectomy rate for DUB: 25 (15.2%) of 165 fell to 12 (6.5%) of 185 (P = 0.014): for CPP: 11 (10.9%) of 101 to 3 (2.9%) of 105 (P = 0.044), as well as for the combined total rate: 86 (25.2%) of 341 to 52 (15.2%) of 342 (P = 0.002). There was a 50% decrease in nonconfirmable pathology for all cases: 21 of 86 at baseline compared to 6 of 52 after intervention (P = 0.049).
  
  
  CONCLUSIONS
  In this 6-month pilot analysis, the use of preoperative hysterectomy checklists for 3 common nonmalignant conditions (fibroids, DUB, and CPP) was associated with a statistically significant decrease in hysterectomy rates and overall nonconfirmable pathology.
authors.affiliation: Department of Obstetrics, University of Virginia Health System, PO Box 801305, Charlottesville, VA 22908, USA. khullfish@virginia.edu
authors.forename: Kathie L
authors.initials: KL
authors.lastname: Hullfish
authors.forename: Erick
authors.initials: E
authors.lastname: Henry
authors.forename: James E
authors.initials: JE
authors.lastname: Ferguson
mesh_terms: D057189:Checklist; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D007889:Leiomyoma / Q000601:surgery; D017699:Pelvic Pain / Q000601:surgery; D011300:Preoperative Care; D011446:Prospective Studies; D058996:Quality Improvement; D014592:Uterine Hemorrhage / Q000601:surgery; D014594:Uterine Neoplasms / Q000601:surgery