LAPAROSCOPIC STERILIZATION - OPINION AND PRACTICE AMONG GYNECOLOGISTSIN SCOTLAND

Objectives 1. To produce a list of evidence-based criteria for good qu ality care relating to female laparoscopic sterilisation. 2. To assess the level of agreement with each criterion among gynaecologists in Sc otland. 3. To obtain an overview of current sterilisation practice for comparison with the agreed criteria. Design 1. Agreement with criteri a assessed by questionnaire survey; 2. Overview of current practice ob tained by questionnaire survey and by casenote review.Setting Scotland . Sample 1. Questionnaire survey: all 132 consultant gynaecologists in NHS practice. 2. casenote review: 988 consecutive women sterilised in 12 representative hospitals. Results The response rate to the questio nnaire survey was 94%. A list of 15 evidence-based criteria was produc ed, covering patient selection, information and counselling, technique s of tubal occlusion and timing of sterilisation. All 15 suggested cri teria gained an overall balance of support among responding gynaecolog ists. Similar impressions of current practice were gained from the que stionnaire survey and from the casenote review. Aspects of practice wh ich measured up well to the agreed criteria included: only 6% of women sterilised were younger than 25 years of age; over 85% of casenotes i ncluded clear documentation that women had been counselled regarding f ailure rate and intended permanency; 88% of sterilisations were perfor med, or directly supervised by, a gynaecologist of consultant or senio r registrar status; and only 2% of sterilisations were undertaken in c ombination with induced abortion. Aspects of practice which compared p oorly with the agreed criteria, and for which recommendations for chan ge have been made, included: only 22% of casenotes mentioned that the option of vasectomy had been discussed; only 30% of gynaecologists ind icated that they provide locally produced information leaflets as an a djunct to counselling; four methods of tubal occlusion (including unip olar diathermy) were in use; and there were wide variations among hosp itals in the use of day-case care, ranging from 19% to 99%. Conclusion s A list of criteria for good quality care in relation to sterilisatio n has been validated by agreement among Scottish gynaecologists. Curre nt practice (as assessed by questionnaire survey and casenote review) has been compared with the criteria and some recommendations for chang e in practice have been made. Following dissemination of these results and recommendations, re-audit will be undertaken in order to identify any changes.