Title : Audit of compliance with NICE quality standards on the management of miscarriage (QS69) at West Suffolk Hospital
Abstract:
Background: Miscarriage is one of the most common complications of early pregnancy, affecting approximately 1 in 5 pregnancies, with the majority occurring during the first trimester. The National Institute for Health and Care Excellence (NICE) quality standards aim to improve the quality, safety, and consistency of healthcare delivery through measurable standards of care. NICE Quality Standard QS69 outlines key priorities in the management of miscarriage, including timely assessment, accurate diagnosis, and management aligned with patient choice. This audit was undertaken to assess compliance with NICE quality standards for miscarriage management at West Suffolk Hospital, focusing specifically on timely access to early pregnancy assessment services, use of transvaginal ultrasound (TVUSS) for diagnosis, and confirmation of miscarriage diagnosis before commencing treatment.
Methods: A retrospective audit was conducted involving patients referred to the Early Pregnancy Assessment Unit (EPAU) between February and April 2025. Data were collected from the EPAU dashboard and electronic patient records. Compliance was assessed against three NICE quality statements: timely review within 24 hours of referral, ultrasound assessment to determine pregnancy location and viability, and confirmation of miscarriage diagnosis through appropriate second assessment where indicated.
Results: A total of 85 patients were included in the audit. Seventy patients (82.4%) were reviewed within 24 hours of referral, demonstrating good compliance with NICE recommendations. Miscarriage diagnosis was confirmed by ultrasound in 74 patients (87%), while 11 patients (13%) were diagnosed through serial human chorionic gonadotrophin (hCG) monitoring. Regarding confirmation of diagnosis, 51 patients (60%) were managed following a single ultrasound assessment where clinically appropriate. Management approaches included expectant management in 59 patients (69.4%), medical management in 15 patients (17.6%), and surgical management in 11 patients (12.9%).
Conclusion: The audit demonstrates good compliance with NICE quality standards for miscarriage management at West Suffolk Hospital. Timely assessment, access to transvaginal ultrasound, and shared decision-making were consistently achieved. Delays beyond recommended timeframes were uncommon and were mainly related to patient preference, early gestation, or service availability. Recommendations include consideration of weekend review pathways for urgent cases, improved documentation of decisions regarding declined investigations, and completion of a re-audit within 6–12 months to monitor sustained improvement.
