An Audit of Hysteroscopic Mechanical Tissue Resection for Uterine Lesions
Dr Pari Shanmuga Raman Gurusamy, Dr Sherif Mito, Dr Bilques Bilques, Dr Hany Mostafa, Dr Mary George
North Tees and Hartlepool Hospitals NHS Foundation Trust, Hartlepool, United Kingdom

DEFINITION OF CRITERIA AND STANDARDS

• MyoSure device can be used to resect intra-uterine tissue growths (polyps and fibroids) under direct vision in both inpatient and outpatient settings
• The scope of this hybrid audit covered all inpatient procedures and 2 week wait outpatient procedures to set a baseline standard for our unit
• AUDIT STANDARDS:
  • Green-top Guideline No. 59 describes Best Practice in Outpatient Hysteroscopy
  • Interventional procedures guidance [IPG704] describes Evidence-based recommendations on hysteroscopic mechanical tissue removal for uterine fibroids

DATA COLLECTION AND METHODOLOGY

• Total number of patients: 95
  • 2 weeks wait patients: 86 cases
    • 67 (78%) were done in the clinic
    • 19 (22%) were done in theatre
• Outpatients = 67 (all were 2ww) vs Inpatients = 28 (19 were 2ww)
• Duration: 01/09/2021 – 31/9/2022
• Source: Paper medical notes, Mediviewer, TrakCare, consultant data collection sheets
• Case identification: Via OPCS codes
• Tool: Excel spread sheets
• Exclusions: Nil

ASSESSMENT OF PERFORMANCE AGAINST CRITERIA AND STANDARDS

• Overall: 75 of 95 (78.9%) postmenopausal
  • Outpatient: 58 of 67 (86.6%) postmenopausal
  • Inpatient: 17/28 (60.7%) postmenopausal
  • Complications
    • Outpatient procedures: 1/67
    • Inpatient procedures: 0/28
    • Age
      • Overall: 62.3
      • Outpatient: 62.3
      • Inpatient: 59.7
      • BMI
        • Overall: 33.4 (of 45 recorded)
        • Outpatient: 35.1 (only 17 recorded)
        • Inpatient: 32.4 (all recorded)
      • Areas of good performance
        • Higher percentage of outpatient procedures vs inpatient procedures
        • High percentage of 1-stop service provision in outpatient group
        • Minimal complication rates in all groups of patients
        • No cancer target breaches including in women requiring more than one appointment
      • Areas requiring improvement
        • Collection of patient satisfaction questionnaires
        • Obtaining written consent for outpatient procedures
        • Ensuring all patients receive information on the outpatient procedure before the RAC (PMB clinic patients receive but not RAC patients)
        • Nearly half of the inpatient MyoSure patients and a third of outpatient MyoSure patients had 2 or more clinic visits

IDENTIFICATION OF CHANGES AND ALTERATIONS TO PRACTICE

• Posting written patient information for hysteroscopy/MyoSure for Rapid Access Clinic patients
• Routine written consent for outpatient MyoSure tissue resection procedures
• Standardisation of reporting of findings with templates
• Consistent use of patient satisfaction questionnaires
• To reduce number of clinic episodes for inpatient procedures

RE-EVALUATION

• In 2024, based on prospective 12 months’ data post implementation of changes