Design: The rate of MIH was evaluated at a single institution. A before-and-after single-phase quality improvement project was undertaken by implementing a bundle of preoperative assessment and surgery performed by a team with MIH expertise.

Setting: Community-focused academic tertiary healthcare center.

Patients or Participants: Women aged 18 years or older undergoing hysterectomy. Patients with malignant pathology and those with missing data were excluded.

Interventions: At this county hospital, a group approach practice is implemented where patients undergo a single “faculty exam” to determine the route of hysterectomy. The physician deciding on the surgical approach may not be the one performing surgery. This can lead to discrepancies between the preoperative plan and the actual surgery, and a high “conversion rate” if the surgeon is not comfortable performing MIH for large uteri. To address this, the quality intervention (QI) involved a group of surgeons with MIH expertise conducting both the preoperative examinations and surgeries for uteri larger than 16 weeks size.

Measurements and Main Results: A total of 833 patients underwent hysterectomy during the study period. Of these, 722 (86.7%) had surgery before, and 111 (13.3%) after the QI. Patient characteristics did not significantly differ between cohorts. Following the QI, a significantly higher proportion of patients underwent MIH (91% vs 73%, P<0.0001). There was no significant difference in uterine weight (513g vs 424g, P= 0.06) or complication rate (11% vs 14%, P=0.33). The rate of same-day discharge significantly increased post-intervention (56% vs 69.3%, P<0.001). More importantly, in the cohort of patients with uteri >500 grams/16weeks, the rate of MIH increased from 36.9% to 75.8% after the QI, p<0.001.

Conclusion: A QI was implemented to increase access to MIH for patients with large uteri. This intervention may lead to sustainable and significant improvements in surgical outcomes in this population.