Reducing Delays in Postoperative Gynecologic Evaluations Through Automated Electronic Alerts

To determine if an electronic health record (EHR)-based quality improvement intervention can decrease the time to gynecologic evaluation for patients presenting to the emergency department (ED) within 30 days of gynecologic surgery.

Through a multidisciplinary approach, key drivers to delays of recognition of postoperative complications were delineated and change ideas explored. In April 2022 an EHR notification was implemented that alerted ED and gynecology providers when patients presented within 30 days postoperatively. For primary analysis, the authors compared patients who presented to the ED October 2021-April 2022 (preintervention) to those who presented April 2022-May 2023 (postintervention) who were admitted after gynecology evaluation. Secondary analysis included all postoperative patients presenting to the ED.

A total of 93 patients were included in the primary analysis, 37 (39.8%) preintervention and 56 (60.2%) postintervention. Mean ages in the pre- and postintervention periods were 41.3 and 50.1 years, respectively, p = 0.01. Baseline characteristics did not otherwise differ. Average time between ED arrival and initial gynecologic evaluation was 6.08 ± 4.83 hours in the preintervention group and 4.25 ± 2.36 hours in the postintervention group. After adjusting for age, compared to the preintervention period, the postintervention period was associated with a 2.26 hour reduction (β = -2.26; 95% confidence interval [CI] -3.78 to -0.74) in the time between ED arrival and initial gynecologic evaluation, p < 0.01. The time between ED arrival and initial gynecologic evaluation also became a more predictable process postintervention. On secondary analysis, median minutes from patient rooming to gynecology first chart opening decreased from 57.1 preintervention to 11.9 postintervention, p = 0.001.

This process improvement project reduced the latency time from ED arrival to gynecologic evaluation.