title: Decreasing Diagnostic Hysteroscopy Performed in the Operating Room: A Quality Improvement Initiative.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Hamilton Health Sciences Centre, McMaster University, Hamilton ON.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Leung
authors.affiliation: Hamilton Health Sciences Centre, McMaster University, Hamilton ON.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Leyland
authors.affiliation: Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON.
authors.forename: Ally
authors.initials: A
authors.lastname: Murji
mesh_terms: D000768:Anesthesia, General / Q000191:economics / Q000706:statistics & numerical data; D017046:Cost Savings / Q000191:economics; D004107:Dilatation and Curettage / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000191:economics / Q000706:statistics & numerical data*; D007318:Inservice Training; D009864:Ontario; D009873:Operating Rooms / Q000191:economics / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000191:economics; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data; D014600:Utilization Review
keywords: Quality improvement; abnormal uterine bleeding; diagnostic hysteroscopy; sonohysterography