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993 Intent of treatment in major gynae-oncology surgery – a quality improvement project in a tertiary teaching hospital
  1. H Asif and
  2. T Nomani
  1. Royal Wolverhampton NHS Trust, Obstetrics and Gynaecology, Wolverhampton, UK


Introduction/Background*Planning and consenting in major gynae-oncology surgery is a meticulous and important process. To maximise benefit to the patient it is imperative that the intent of treatment when planning major surgery is precise and specific. Additionally, to uphold informed consent and fulfil patient expectations, individuals must be accurately informed of the procedure they will undergo – a sentiment reflected in local, national, and international guidelines.

Methodology A quality Improvement project was conducted at a UK tertiary centre (New Cross Hospital, Wolverhampton) that aimed to evaluate the intent of treatment in major gynae-oncology surgery. 48 patients who underwent major procedures between October and December 2020 were selected for analysis. The primary objective was to ascertain the concordance between pre-operative planning and the actual procedure performed – this was determined by comparing the pre-operative documents with operation notes, and thereby expressing the concordance between procedures in the two as a percentage. Reasons for discrepancies found between pre-operative plans and the operations were then established. Other aspects evaluated included who examined patients (and when they were examined), how imaging was considered in pre-op decisions, and continuity of care throughout the surgical process.

Result(s)*It was found that overall concordance was 86.6% - most patients underwent procedure in the manner that had been planned and expected. Reasons for discrepancy (i.e., the 13.4% discordance) was categorised into 4 main categories: 1. Procedure not tailored to findings of imaging; 2. Unexpected intra-op findings; 3. Multiple surgical approaches consented; and 4. changes to surgical approach in vulvectomy. 89.4% of patients were examined in the pre-operative assessment – of those, 97% within 4 months of the operation. 76% of patients were operated on by the examining consultant, although this was found not to affect concordance.

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Conclusion*Departmental recommendations were established from this Quality Improvement Project - The importance of considering imaging pre-operative decisions was emphasised, as well as recommendations to tailor consent to individuals in gynae-oncology surgery. Further recommendations included encouragement of sufficiently defining intended treatments in consent documentation, and promoting continuity/consistency of consultant in surgical care.

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