1. Out Patient Hysteroscopy Audit 2014
RAJVINDER KHASRIYA, ROSALIND PRATT, WASIM LODHI

2. Introduction
Outpatient hysteroscopy is an established diagnostic test that is in widespread use across the UK.
Miniaturised endoscopic equipment used to directly visualise and examine the uterine cavity
Outpatient hysteroscopy is indicated primarily in the assessment of women with abnormal uterine bleeding, but is also employed in the diagnostic work-up of reproductive problems.

3. Introduction
RCOG recommends all gynaecology units should provide a dedicated outpatient hysteroscopy service to aid management of women with abnormal uterine bleeding.
There are clinical and economic benefits associated with this type of service.
We wanted to audit our service against the RCOG guidelines to check we comply with them and identify areas of improvement
We also wanted to find out the patient views on the service we provide

4. Audit against RCOG Green Top Guideline 59 – Best Practice in Out Patient Hysteroscopy
Written patient information should be provided before the appointment and consent for the procedure should be taken.
Women should be advised to consider taking standard doses of non-steroidal anti-inflammatory agents (NSAIDs) around 1 hour before the procedure
Routine administration of local anaesthetic can be considered, especially in postmenopausal women.
Blind cervical dilatation is unnecessary in the majority of procedures.
Vaginoscopy should be the standard technique for outpatient hysteroscopy

5. Method Retrospective Audit Prospective audit
From Outpatient hysteroscopy database
January to March 20
Prospective audit
Proforma filled in during OP hysteroscopy clinics
March and April 2014
Patient experience questionnaire
Completed after the procedure

6. Results Prospective Retrospective Total 26 patients
7 (27%) Target referrals, 19 routine
18 (69%) consented in clinic prior to the procedure, 8 not consented prior to attending – consented in OP hysteroscopy
Retrospective
83 patients
Total
n = 109 patients
35 postmenopausal, 73 premenopausal
Age 28-76, mean 47

7. Previous Vaginal deliveries
No. of Patients
Number of Vaginal Deliveries

8. Indication

9. Anaesthetic, Cervical dilatation and Vaginoscopy
Prospective data only
Cervical dilatation performed for 3 (12%) patients
5 patients received local anaesthetic (19%)
3 of these were postmenopausal (43% of postmenopausal women)
Vaginoscopy was attempted in 20 patients (77%)
It was successful in 19 patients (73%)

10. OP hysteroscopy findings

11. Operative procedures 9 polypectomies were performed
12 IUCDs were removed
8 IUCDs were inserted
28 (26%) referred for GA procedures – 15 for polypectomy, 4 for myomectomy, 1 for Novasure ablation

12. Patient satisfaction survey
21 received a patient information leaflet (91%)

13. Patients were asked to rate the following 1 – 10, 1 being unsatisfied, 10 being very satisfied

14. Patients were asked to rate the level of pain experienced, 1 being none, 10 being severe

15. Analgesia 9 took analgesia before (39%) 1 took analgesia after
3 paracetamol, 2 ibuprofen, 2 Diclofenac, 1 Naproxen, 1 tramadol.
1 took analgesia after
Ibuprofen

16. Overall 22 would recommend outpatient hysteroscopy to a friend (96%)
4 would prefer to have the procedure under general anaesthetic (17%)

17. Conclusion – positive findings
Most patients received an information leaflet and were consented in clinic at the time of booking the procedure
Cervical dilatation was rarely needed, and vaginoscopy was performed for the majority of patients and was mostly successful
Patients are mostly happy with our service, and would recommend it

18. Recommendations
The minority of patients received analgesia either orally or as local anaesthetic – should we be encouraging more patients to take NSAIDs 1 hour before the procedure i.e. counsel them at the time of booking the procedure
Can we improve our patient information leaflet – highlighting the advice to take analgesia an hour before, and displaying our patient satisfaction scores
Should we be doing more out patient operative hysteroscopy to prevent the need for follow up GA hysteroscopy? Would Myosure help with this?