Impact of a Trauma Center and Surgical Priority Classification System on Gynecologic Emergency Surgery (GynES) Quality Measures

Abstract

Study Objective We evaluated the impact of opening a Level I Trauma Center on quality measures in GynES. The primary outcome was the time elapsed between case request and patient arrival to the operating room (R:R time). Design This retrospective cohort study compared cases in 2017 (pre-intervention) to 2019 (post-intervention) in a convenience sample. Setting Urban academic tertiary-care hospital, single institution. Patients or Participants Women were included (n=228) if they presented to the Emergency Department and underwent GynES for one of the three indications: ectopic pregnancy, miscarriage, or adnexal torsion. Interventions The intervention period in 2018 included modernizing the Emergency Department, instituting a surgical priority classification system (R:R time targets: A Measurements and Main Results Two reviewers assigned priority class retrospectively for pre-intervention cases (Kappa=0.60). A third reviewer adjudicated discrepancies. R:R time was assessed by difference of means [95% CI] and percent compliant with targets using Welch's T-Test and Fisher's Exact Test (alpha=0.05), respectively. Interrupted time series logistic regression evaluated for secular trends. When compared to 2017 (n=111), R:R time in 2019 (n=117) was significantly reduced for class A cases (-42min [-67 to -17min], p=0.02) and class B cases (-59min [-99 to -20min], p=0.004). Overall compliance significantly improved from 50% to 71%, p=0.002. Logistic regression did not find confounding from pre-intervention trends. Patient and case characteristics were similar except for insurance mix, p=0.04. Conclusion Implementation of a Level I Trauma Center and surgical priority classification system significantly reduced delays for the most urgent gynecologic emergency surgeries.