Title : Day-case vs outpatient hysteroscopy: A retrospective audit of compliance with RCOG GTG 59 at a district general hospital in North Wales
Abstract:
Background/Objectives: Outpatient hysteroscopy is the gold standard for uterine investigation per RCOG Green-top Guideline 59 (2024). This retrospective audit evaluated compliance with GTG 59 at Ysbyty Glan Clwyd, North Wales, focusing on outpatient success rates, day-case escalation, cancer detection, diagnostic intervals, and pain relief documentation.
Methods: Case notes were reviewed for all 78 day-case hysteroscopy procedures (July 2024–December 2025). Outpatient procedure numbers were extracted from the Ward 19A logbook. Standards applied: RCOG GTG 59 (2024), GTG 67, GTG 44, GPP 16, NICE NG12, and NHS Faster Diagnosis Standard (FDS).
Results:
|
Standard / Metric |
Result |
Target |
Status |
|---|---|---|---|
|
Total procedures (OP + DC) |
594 (516 OP + 78 DC) |
— |
— |
|
Outpatient rate |
86.9% |
≥ 90% |
NOT MET |
|
OP diagnostic success |
87.6% |
≥ 97% |
NOT MET |
|
OP polypectomy success |
86.6% |
≥ 95% |
NOT MET |
|
OP ablation success |
40% (n=5) |
≥ 77% |
NOT MET |
|
Cancer detection rate |
4/78 (5.1%) |
All → MDT |
MET ? |
|
28-day FDS met (USC cases) |
0/4 (9w+3d to 16 wks) |
≥ 28 days |
NOT MET |
|
LA / Entonox documented |
50/78 (64%) |
100% |
PARTIAL |
|
Ward 19A before DC escalation |
8/28 (28.6%) |
100% |
NOT MET |
Conclusions: While the 86.9% outpatient rate reflects adherence to the GTG 59 outpatient-first principle, all three outpatient success rates fall below national standards. Insufficient documentation of day-case justification, analgesic discussion, and Ward 19A pathway compliance represent key quality improvement targets. Failed outpatient attempts contributed to FDS non-compliance in all 4 USC pathway cancer cases, highlighting the importance of timely escalation by any appropriately trained consultant without requiring oncology referral. Re-audit at 6–12 months is recommended.
