Title:

Quality Improvement Project on Outpatient Hysteroscopy Service at North Manchester General Hospital

N.Iftikhar,O.Oghodho,D.Mbanaso,A.Olateju,N.Hashmi,P.Jothilakshmi

Background:

Hysteroscopy is a common and valuable procedure used to diagnose and treat gynaecological conditions arising in the uterus.

The majority of women and people have an acceptable experience of outpatient hysteroscopy, with pain levels tolerable to them and rapid recovery. However, for some women it is an unpleasant, and even traumatic, experience because of the pain.

A third of patients undergoing an outpatient hysteroscopy report pain levels at seven or above out of 10 however patient acceptability/satisfaction rates are consistently well above 90%, likely reflecting the brevity, safety and convenience of the procedure. The patient acceptability/satisfaction rates also indicate that pain may not be the main factor in their decision making.

To allow women or people to make informed choices it is vital that clear, accurate written and verbal information is provided, at the time of referral, or beforehand and at the procedure appointment. This should support choices including whether the person wants to proceed with a hysteroscopic procedure and if so, preferences for treatment setting, pain control and type of anaesthesia.

Objective:

To evaluate the outpatient hysteroscopy service against set standards and to evaluate the experiences of women attending outpatient hysteroscopy at North Manchester General Hospital through patient feedback survey.

Design:

A retrospective review of patients who had undergone outpatient hysteroscopy at North Manchester General Hospital from 1st January 2021 to 30th April 2021 for 4 months  and the patient feedback was collected prospectively for a period of 3 months between 1st September 2022 till 30th November 2022.

Methods:

A total number of 73 patients were randomly selected. Data was collected retrospectively on a predesigned proforma and was analysed on excel. The feedback survey was designed based on the content from existing BSGE feedback surveys and the data was collected from 50 patients who attended outpatient hysteroscopy service.The satisfaction survey comprised of questions regarding patient's experience before, during and after the consultation. 

Results:

87%(n=64) of the women were in the peri or postmenopausal age group.55% l(n=40) of the women had a fast-track referral.The main indication of the referrals was postmenopausal bleeding (44%, n=32). The written consent was obtained in all the patients(100%).There was no written documentation available whether patient information leaflets were provided to any patient .96% (n=70) of the patients had no documentary evidence that analgesia was given pre-procedure. There was no documentation about vaginoscopic approach in 97% (n=71) of the cases, cervical Dilatation in 96%(n=70) and use of Local analgesia in 99% (n=72) of the patients.

99%(n=72) of the patients had no complications. The failure rate was 19%(n=15) with cervical stenosis being the commonest cause (73%, n=11). There was no documented evidence of any complications in any patient.

In the patient feedback survey there was  no documentation by the staff about the procedure performed  in >50% of the cases.82%(n=41) of the patients received written information before the procedure and 72%(n=36) received advice about the painkillers.96% (n=48) had good to excellent views about the waiting area and reception.Majority of the patients strongly agreed about the advice given during the consultation.90%(n=45) felt some degree of pain,78%(n=39) felt anxious,56%(n=28) had some degree of distress,24% (n=12)felt faint,36% (n=18) felt embarrassed and 90% (n=45) felt in control during the procedure.98% (n=45) had overall good experience and 90% (n=45) preferred to have the similar procedure in the future.The mean score rating of the overall level of care received was 7 out of 10.

 Coclusion:

The outpatient hysteroscopy service has a high success rate of and a high level of patient satisfaction. Several areas were identified to improve including improvement in documentation and provision of adequate information and pre procedure analgesia  advice to the patients.

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