Gynecology Patient Management Metrics

Outpatient and Inpatient Investigations

• Timeline from incomplete outpatient investigations to complete inpatient investigations significant for patient management.
• Recommended to track the number of women taking pre-procedure analgesia and evaluate pain scores during and after hysteroscopy.

Endometrial Sample Quality

• Adequate percentage of endometrial samples crucial for accurate diagnosis.
• Attention to false negative outcomes in investigations highlights the importance of thorough diagnostic protocols.

Cancer Diagnosis Timeline

• Monitoring the timeline from referral to cancer diagnosis is critical for timely treatment initiation.

Hospital Admissions

• Track unscheduled hospital admissions following Ambulatory Gynaecology appointments to assess the quality of clinical management.

Patient Experience

• Focus on patient experience metrics to identify areas for improvement in care delivery.

Withdrawal from Diagnostic Process

• Monitor the number of women who withdraw from the diagnostic track, as this might indicate issues with the process or patient satisfaction.

Diagnostic and Treatment Recommendations

• Avoid isolated dilation and curettage as the first-line method for endometrial sampling in postmenopausal bleeding.
• Endometrial sampling should ideally be combined with transvaginal ultrasound and possibly hysteroscopy.
• Vaginoscopic approach preferred for outpatient hysteroscopy due to better patient tolerability.

Pain Management Recommendations

• Suggest taking NSAIDs prior to hysteroscopy to reduce potential post-procedure pain, with instructions to be included in appointment letters.

Persistent Bleeding Investigations

• Immediate consideration for hysteroscopy and repeat endometrial biopsy in cases of unexplained or recurrent postmenopausal bleeding.
• Maintain a low threshold for re-evaluating women with previous reassuring investigations.

Transvaginal Ultrasound Protocol

• Increased endometrial thickness (≥ 11mm) in postmenopausal women without bleeding warrants further investigation.
• Women on hormone replacement therapy (HRT) experiencing abnormal bleeding should be referred for investigation.

Prompt Access to Gynaecology Services

• Women should be seen within 28 days for postmenopausal bleeding investigations.
• Encourage visits to Ambulatory Gynaecology clinics for timely assessments.

Comprehensive Assessment Guidelines

• All gynaecology services should be equipped to investigate postmenopausal bleeding.
• Implement fast-track pathways for women awaiting investigation for postmenopausal bleeding when comprehensive services are unavailable.

Endometrial Sampling and Hysteroscopy

• Women with postmenopausal bleeding and endometrial thickness ≥ 4mm should undergo endometrial sampling.
• Diagnostic hysteroscopy advised when focal endometrial pathology is detected or if the endometrial thickness exceeds 4mm.
• Tamoxifen users with abnormal uterine bleeding should receive diagnostic hysteroscopy due to limitations of transvaginal ultrasound.

Complementary Imaging Techniques

• Utilization of transabdominal ultrasound to complement transvaginal ultrasound for cases with an enlarged uterus or pelvic mass.

This quiz explores various metrics related to outpatient and inpatient investigations in gynecology. Participants will assess topics such as pain management during hysteroscopy, adequate sample collection, and patient experiences throughout the referral and diagnosis process. Gain insights into improving clinical outcomes in gynecological care.