Title : An audit of timelines for women presenting to outpatient hysteroscopy services with postmenopausal bleeding
Abstract:
Background: Outpatient hysteroscopy is an invaluable tool for investigations and management of postmenopausal bleeding. Since June 2021 University Hospital Waterford runs a “one-stop-shop” where women have an ultrasound, a hysteroscopy, biopsy or removal of polyp if indicated. An increase in the use of HRT has resulted in an increase in the number of referrals for investigations of PMB or AUB.
Objective: Given up to 9% of all women referred in for assessment of postmenopausal bleeding will have a diagnosis of endometrial cancer1, we audited patients seen within a set time-frame to ascertain if we met the gold standards as set in the Irish guidelines. We also set to audit the timeline from initial primary care referral to being seen, and the number of cases completed at the first visit.
Methods: This was a retrospective data analysis of all women referred to a tertiary centre “one-stop-shop” service from January 2023- August 2023. All patient information was anonymised and entered into a secure password-encrypted database and later analysed. The National Women & Infants Programme National Clinical Practice Guideline for Assessment & Management of Postmenopausal Bleeding 2022 was the standard used.
Results: 125 patients were seen within 8 months. 101/125 patients (80.8%) were seen within 28 days or less, against a gold standard of 100%. The number of cases completed and discharged at the first visit was 79/125 patients (63.2%). 45/125 (36%) were PMB on HRT.4 FIGO endometrial cancers were diagnosed, giving an incidence of 3.2% of endometrial cancer within our cohort; 3 were Grade 1-2 and 1 was Grade 3. 3 cases were seen within the gold standard time frame of 28 days or less. The other (Grade 1-2) was seen at 36 days from initial referral.
Conclusion: This audit reflects the increased burden on our services and the need for additional resources to achieve the KPI target of 100% of referrals seen within 28 days. Supporting primary care physicians to ensure patients are appropriately referred is pertinent to allow timely assessment.
