Admission for treatment--does the degree of training of colposcopist make a difference?

The aim of the study was to assess whether the degree of training of colposcopist making the decision has an influence on the number of inpatient treatments.

A retrospective audit was performed of patients who underwent surgical excision of cervical transformation zone for cervical intraepithelial neoplasia over a period of 23 months from February 2003 to December 2004. Case notes were reviewed for patients undergoing inpatient treatment, and database interrogation was done for patients who had an outpatient treatment. Data were collected with regard to indication for referral, person making the decision, and the indications for inpatient treatment.

Three hundred thirty-one cases were reviewed. Inpatient treatment was performed in 61 (18.42%) and outpatient in 270 (81.57%). Inpatient procedures were chosen in 13% of cases by a consultant, 27% by a trained nurse, 18% by a trainee, and 14% by an associate specialist. The main indications where there was a difference in decision making was anxiety, access, and size of lesion.

We achieved the standard of performing loop excision as an inpatient procedure in less than 20% of cases. A nurse and a trainee, compared with a consultant, referred a greater proportion of patients for an inpatient procedure. Improved training and confidence building may achieve a further reduction in the inpatient referral.