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Outpatient Hysteroscopy

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Outpatient Hysteroscopy
A Ahmad, M Vellayan: Gloucestershire Hospitals NHS Foundation Trust, UK

Outpatient hysteroscopy is an established diagnostic test that is in widespread use across the UK. Outpatient hysteroscopy, whether diagnostic or operative, is successful, safe and well tolerated.
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 service1
The recent changes in tariff has incentivized OP hysteroscopy by fixing a rate of £457 instead of the old tariff of £260. The 2013-14 PBR tariff has further incentivized therapeutic procedures in outpatient clinic by offering the option of "flexibility tariffs"
The aim of this pilot study is to assess reasons for diagnostic day-case hysteroscopy in order to move to outpatient hysteroscopy within GHNHS trust.
Patients and Methods:
This is a service improvement audit to identify reasons for day case hysteroscopies in Gloucestershire NHS Trust. This is a prospective audit for 5 weeks in order to identify reasons for not having an outpatient procedure. The procedures include: Hysteroscopy and curettage, Hysteroscopy & biopsy, Hysteroscopy, Levonorgestrel IUS insertion and day case hysteroscopy for USS diagnosis of polyp without prior confirmation through OP hysteroscopy.
Outpatient hysteroscopy was not offered for 31% of patients. Almost quarter of GA hysteroscopies were due to failed pipelle biopsy in outpatient gynaecology clinic. 11% had a diagnosis of uterine polyp based on ultrasound scan and no polyp was found on hysteroscopy. A quarter of patients had declined outpatient hysteroscopy.

In conclusion:
OP Hysteroscopy should be offered to all patients as the first choice.
Failed pipelle in clinic should not be considered as a contraindication to offer outpatient hysteroscopy.
Ultrasound is not accurate in the diagnosis of uterine polyps and should not be an indication to book day-case hysteroscopy

[1] Hysteroscopy, Best Practice in Outpatient (Green-top 59), www.rcog.org.uk. Last accessed 01 May 2013

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