Data from a post-use questionnaire were used to assess the usage of the OfficeSPEC Disposable Vaginal Speculum, specifically its effectiveness, efficiency, and acceptability in clinical, hospital, and austere settings. The OfficeSPEC speculum earned an efficacy rating of 4.6/5, an efficiency rating of 4.5/5, and an acceptability rating of 4.6/5; overall usability in deployed contexts was favorable. Plastic received a score of 3.4, metal received a score of 4.2 (p 0.001), and OfficeSPEC had a score of 4.5 (p 0.001). The disposable speculum was found to be a suitable alternative to typical metal ($209,100) and plastic ($319,175) in the OfficeSPEC cost analysis. Conclusion: When the OfficeSPEC speculum was evaluated within a usability framework, it was demonstrated to be a realistic, feasible choice in all situations, especially the forward-deployed scenario.
Introduction of Disposable Vaginal Speculum
The Disposable Vaginal Speculum is the fundamental instrument of every healthcare worker performing gynecological examinations. Speculums come in a variety of sizes, materials, and extra features such as light attachments and suction ports. The choice of a given speculum is mostly determined by provider preference, although it may also be influenced by availability or institutional regulation.
Although military physicians perform gynecological examinations in the same way as civilian physicians, the environment in which these examinations are performed can vary and provide regular problems. Gynecological examinations could take place in a makeshift clinic or room, and lighting sources were frequently generator-dependent. Thus, in a harsh environment, such as a military deployment or humanitarian mission, equipment availability is frequently a deciding factor.
The goal of this study was to evaluate the possibilities for military uses of the OfficeSPEC speculum (OBP Medical, Lawrence, Massachusetts) (Fig. 1). We want to assess the usability of the OfficeSPEC vaginal speculum in military treatment facilities and forward-deployed sites using three parameters: effectiveness, efficiency, and acceptability1,2. The study was authorized by the Institutional Review Board at Walter Reed Army Medical Center (WRAMC).
Materials and Methods:
A prospective observational pilot study was designed to evaluate the use and military applicability of the OfficeSPEC disposable, self-lighted speculum. The OfficeSPEC is a single-use, disposable vaginal speculum that is FDA-approved and commercially available (http://www.obpmedical.com/). OBP Medical supplied approximately 150 speculums to the WRAMC Department of OB/GYN for this study. WRAMC clinicians (OB/GYN nurse practitioners, residents, and staff) distributed the speculums, and WRAMC staff physicians deployed them. Deployed physicians were given two boxes of speculums; postage was covered in full by OBP Medical, and the speculums were utilized at the provider’s discretion. In battle zones, deployed clinicians performed gynecological examinations. Patient contacts took place at battalion aid stations and Level 2 and 3 medical care facilities.
WRAMC providers had speculums on hand for use in the clinic, inpatient floor consults, and the emergency room. Traditional Disposable Vaginal Speculum, traditional plastic speculums, or the OfficeSPEC speculum were available to providers performing standard vaginal examinations. Each provider was free to select their speculum. The gynecological pelvic examination standard of care remained unaffected.
An anonymous post-utilization questionnaire containing 12 questions was completed by providers (Table I). Participants were asked to rate their comments on a 5-point scale ranging from Strongly Agree to Strongly Disagree. Providers also specified the location of the examination: clinic, hospital ward, emergency room, simulated pelvic model, or deployed situation. The same questionnaire was filled out by deployed providers. The information gathered was classified into three areas (as shown in Table I): effectiveness, efficiency, and acceptability.
Additional data was acquired, including the average number of Disposable Vaginal Speculum performed per day at the WRAMC Gynecology department, as well as the cost of equipment and supplies. The adjusted unit cost, indicated by the cost of a speculum peruse, and expenses spent with the device’s functioning, notably lights, cables, and sterilization supplies, were used in a cost analysis. Clinic invoices were used to collect data for cost analysis.
Metal speculums were assessed utilizing an amortization over the metal speculum’s estimated life of 5 years (and 2.5 years for the light cable used with the plastic speculums). SPSS for Windows, Version 16.0, was used for statistical analysis (SPSS, Chicago, Illinois; 2007).
Results:
There were 78 completed questionnaires. Staff physicians, residents, and nurse practitioners were among those polled. WRAMC providers were given access to the OfficeSPEC speculum, and 31 interactions were analyzed in an austere deployed situation. The demographic breakdown of all 78 surveys is shown in Table II; 40% were conducted in a deployed setting and 60% in a hospital/clinic. 62% were staff, while 38% were residents. 45% of those interviewed had prior experience working in austere (deployed) conditions, while 55% did not.