Admission for Treatment???Does the Degree of Training of Colposcopist Make a Difference?

Abstract

Because of concern over the number of patients admitted to the hospital for cervical intraepithelial neoplasia (CIN), a retrospective audit was carried out over a 23-month period in the years 2003 to 2004, during which time 331 women presented for surgical excision of the cervical transformation zone because of CIN. The rate of admission to the hospital was 18.5%. Nurse colposcopists treated 96 women during the period under review. Another 78 procedures were done by trainees being certified for colposcopy, 43 by associate specialists, and 114 by consultants. Inpatient excisional biopsy was performed because of cervical glandular intraepithelial in 6 of 61 women who were admitted. Seventeen other inpatients had persistent borderline and mild changes, whereas 38 had moderate or severe dyskaryosis on smear examination. Excision was offered only when abnormal colposcopic findings were confirmed. Outpatient care was progressively more frequent when patients were seen by a nurse, a trainee, an associate specialist, or a consultant. Nurse colposcopists referred 27% of the women they saw. The figures for trainees, associate specialists, and consultants were 18%, 14%, and 13%, respectively. The most frequent indications for inpatient referral were anxiety, difficult access, a relatively large lesion, and the need for repeat treatment. For other indications, there were no marked differences in inpatient referral relating to the degree of training in colposcopy. Fewer than one fifth of women with CIN in this study underwent loop excision on an inpatient basis. Improved supervised training, increased confidence, and better patient counseling hopefully will further lower the proportion of women who are admitted for this procedure. Morbidity from general anesthesia would be correspondingly reduced.