Killing the Koilocytes: Optimizing the Management of Cervical Dysplasia Within Graduate Medical Education [ID 1618]

INTRODUCTION: Residency programs are naturally limited in the continuity of patient care due to rapid turnover of physicians in training. We hypothesize that this system-level factor may affect patients’ social determinants of health, which can be addressed across ACGME-accredited obstetrics and gynecology programs with the implementation of a dysplasia tracker. METHODS: This IRB-exempt quality improvement study included 1) retrospective review of timing from diagnosis of abnormal cytology to colposcopy/loop electrosurgical excision procedure (LEEP) from October 2022 to October 2023, and 2) implementation of a dysplasia tracker from October 2023 to July 2024. Primary outcomes were time from diagnosis to intervention; secondary outcomes were rates of affected patients whose primary language was identified as a language other than English. RESULTS: Pre-intervention: 89.6% (n=115) of patients were managed appropriately according to ASCCP Guidelines, 4.3% (n=5) were lost to follow-up. Time from abnormal cytology to colposcopy was greater than 6 weeks for 84.3% (n=91) of patients, with an average of 18.2 weeks (±14.6 weeks). Average time from colposcopy to LEEP was 17.9 weeks (SD ±15.6 weeks). Fourteen patients (12.2%) had pregnancies affecting time to intervention. Six patients were identified to meet criteria for referral to a gynecologic oncologist, five of whom were successfully evaluated. Intervention phase (n=138) demonstrated that an overall significant reduction in time of abnormal cytology to intervention was appreciated for both colposcopy and excisional procedures (61.5% reduction, P <.001, and 55.3%, P <.005). A significant difference in ESL patients receiving their excisional procedure was appreciated. CONCLUSIONS/IMPLICATIONS: Use of a dysplasia tracker effectively reduces time from diagnosis to intervention for patients with cervical dysplasia. More patients with cervical cancer were identified/effectively seen by a gynecologic oncologist, and pregnant patients received closer surveillance postpartum.