National guidance on gynaecological @entity5 management: an audit of gynaecological XXXX services and management in the South East of England.

@entity5 @entity1 @entity43
OBJECTIVE: To evaluate the appropriateness of the structure and the process of care for gynaecological @entity5 against national guidelines. SETTING _ SAMPLE: Incident cases of @entity43 managed between 1 January, 1999 and 31 December, 2000 in the South East of England. METHODS: Completion of an audit form, by a researcher, using the clinical record. Qualitative interviews with gynaecologists at each hospital. MAIN OUTCOME MEASURES: Whether hospitals meet the requirements for being a 'centre' or a 'unit' for gynaecological @entity5 and whether gynaecologists manage @entity43 according to the guidelines. RESULTS: Stage was recorded in the notes of 53% (262/492) of @entity1 with @entity43 but information to assist in determining stage was recorded in 86%. Of @entity1 who had a stage recorded by the consultant, who should have had a laparotomy and be referred for chemotherapy, 81% (169/209) were managed according to the guidelines, ignoring whether there was removal of disease to nodules of less than 1 cm. Stage was recorded in the notes of 60% (188/315) of @entity1 with @entity5 , although information relevant to staging the @entity1 was recorded in 66%. Overall 76% (142/188) of @entity1 with stage recorded in the notes were managed according to the guidelines but 40% (127/315) of @entity1 audited were not assessable. Only one site met the criteria for being a @entity5 centre. Of the remaining sites, most striking was the inability to assemble a team of professionals, including a radiologist, a pathologist and an oncology nurse to discuss individual @entity1 care. CONCLUSIONS: Retrospective note audits will be hampered by missing data in the clinical record until systems are developed to improve the quality of notes. This research suggests that guidelines based on FIGO staging for the @entity43 are not followed and that this may be associated with incomplete @entity5 management teams.
