Audit of workload in gynaecology: analysis of time trends from linked statistics.
Ferguson JA., Goldacre MJ., Henderson J., Gillmer MD.
OBJECTIVE:To report on trends in workload patterns in gynaecology using linked statistical data. DESIGN:Retrospective analysis of linked abstracts of hospital inpatient and day case records for patients treated in the National Health Service in gynaecology. SETTING:Six health districts in the south of England covered by the Oxford record linkage study. SUBJECTS:Records for hospital admissions to gynaecology (excluding obstetric admissions) from 1975 to 1985. MEASUREMENT AND MAIN RESULTS:Inpatient episodes increased by 23.5% and day case episodes increased by 13.1%. More people treated contributed about 90% and increased readmissions contributed about 10% to the increase in workload. The workload was decreased by strike action in 1975 and 1981-2. Average length of stay decreased substantially and consistently over the 11 years. Emergency readmissions increased annually by an average of 2.7%. Admission rates in 11 groups of surgical procedures accounting for 85% of all gynaecological inpatients are reported, and increases occurred in 10 of the 11 groups. For example, average increases in annual admission rates were 1.0% for sterilization, 1.9% for legal abortion and 8.2% for biopsy of the cervix, the rate for dilatation and curettage decreased by 1.4%. CONCLUSIONS:The increase in admission rates in gynaecology was almost entirely due to increases in numbers of people treated. The rise would have been even greater if the increase in private patients had been considered. The increase may reflect increased expectations on the part of patients and their doctors, advances in technology and increased bed availability due to declining lengths of stay.