Education And Debate

Management for Doctors: Using information for managing clinical services effectively

BMJ 1995; 310 doi: (Published 01 April 1995) Cite this as: BMJ 1995;310:848
  1. Tim Scott, director, health strategiesa,
  2. Peter Jackson, consultantb
  1. a Barnes Hospital, Cheadle, Cheshire SK8 2NY
  2. b Department of Obstetrics and Gynaecology, Huddersfield Royal Infirmary, Huddersfield HD3 3EA
  1. Correspondence to: Mr Scott.

    Case study

    The first report of the Audit Commission suggested that cases suitable for day surgery were being treated inefficiently.1 Huddersfield featured well below the median for the percentage of those procedures that were performed as day cases. This prompted a local review.

    One of the procedures was dilatation and curettage. The Audit Commission suggested that 86% of these procedures should be performed as day cases despite the fact that fewer than 50% of these were being performed as day cases in half the districts surveyed. Huddersfield was stated to have a rate of 32%. The gynaecological clinical audit group carried out an initial review using information from the computerised clinical information system of all dilatation and curettage procedures performed during the previous two years. The audit meetings are attended by all medical staff working in the department and are open to nurses, nurse managers, and medical students. They are chaired by a consultant who is also the gynaecological representative on the clinical directorate.

    A total of 966 cases of dilatation and curettage had been carried out in the two years. The survey revealed that 23.5% of the patients were under the age of 35 years (fig 1). The most common presenting symptom was excessive or frequent menstrual losses (38% of all cases), with irregular bleeding, intermenstrual bleeding, and infertility being other less common symptoms. None of the patients under the age of 50 had malignant disease. Even in patients presenting with postmenopausal bleeding only 12.1% had either malignant disease (adenomatous or squamous carcinoma) or potentially premalignant changes (atypical endometrial hyperplasia) (fig 2).

    fig 1

    Ages of patients who had dilatation and curettage. Values are percentages

    fig 2

    Findings on dilatation and curettage. Values are percentages

    The clinicians agreed that a dilatation and curettage was essentially a diagnostic test and that its most vital …

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