ABSTRACT
OBJECTIVES: This study aimed to apply Cumulative Summation (CUSUM) analysis as a tool to monitor robotic sacrocolpopexy (RSCP) proficiency over time. METHODS: A retrospective analysis of all women who underwent RSCP between September of 2008 and December of 2011 at the University of North Carolina at Chapel Hill. The performance for 2 attending surgeons was analyzed sequentially over time. Intraoperative complications such as genitourinary or gastrointestinal tract injury, conversion to laparotomy, pulmonary embolus, hemorrhage, and blood transfusion, were identified by International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes. A successful outcome was defined as no intraoperative complications. The target value of success was set at less than 10% complications. CUSUM analysis was then sequentially applied to all RSCP cases for 2 attending surgeons. RESULTS: Over 27 months, 169 RSCPs were performed. The first surgeon performed 107 RSCPs and the second surgeon performed 62 RSCPs with 8 (7.4%) and 3 (4.9%) intraoperative complications, respectively. Total complications included 7 (4.1%) cystotomies, 2 (1.2%) vaginal lacerations, 1 (0.6%) blood transfusion, and 1 (0.6%) bowel perforation. A CUSUM graph was created for each surgeon. CONCLUSIONS: CUSUM analysis was successfully applied to monitor RSCP proficiency. Such testing of individual successive procedural outcomes with CUSUM may offer an objective tool to aid in physician self-assessment.
Subject(s)
Clinical Competence , Gynecologic Surgical Procedures/standards , Robotics/standards , Female , Gynecologic Surgical Procedures/adverse effects , Humans , Postoperative Complications/etiology , Retrospective Studies , Treatment OutcomeABSTRACT
INTRODUCTION: One in 5 women is a victim of sexual assault. This study examines the administration of emergency contraception to victims of sexual assault in North Carolina hospital emergency departments. METHODS: One hundred seventeen surveys were mailed to hospital emergency departments across the state to determine their emergency contraception practices for victims ofsexual assault. The survey contained 11 questions about emergency contraception practices for victims. RESULTS: Of the 117 surveys, 103 were returned revealing that just over 50% of the hospitals in North Carolina treated victims with emergency contraception without exception. Both dispensing emergency contraception and providing information about emergency contraception were significantly associated with having a sexual assault nurse examiner program. CONCLUSION: Results from this study demonstrate inconsistent provision of emergency contraception to victims of sexual assault; however, there is greater consistency of emergency contraception use by emergency departments using sexual assault nurse examiners.
