Quality standard

Quality statement 2: Outpatient hysteroscopy

Quality statement 2: Outpatient hysteroscopy

Quality statement

People with heavy menstrual bleeding and suspected submucosal fibroids, polyps or endometrial pathology are offered outpatient hysteroscopy. [new 2020]

Rationale

Outpatient hysteroscopy is recommended in preference to pelvic ultrasound for investigating suspected submucosal fibroids, polyps or endometrial pathology. When carried out in accordance with the Royal College of Obstetricians and Gynaecologists' green-top guideline no.59 on hysteroscopy, best practice in outpatient, it is an efficient and safe technique with a low risk of complications, pain and distress for most people. Before carrying out hysteroscopy, the healthcare professional should discuss the procedure with the person and advise on the possible alternatives. This will ensure people have a positive experience and trust in their clinician.

Quality measures

Structure

a) Evidence of local arrangements to ensure that outpatient hysteroscopy services are organised according to the Royal College of Obstetricians and Gynaecologists' green-top guideline no.59 on hysteroscopy, best practice in outpatient, for example facilities are adequately sized, equipped and staffed.

Data source: Local data collection, for example service protocols.

b) Evidence that healthcare professionals are trained to perform outpatient hysteroscopy procedures according to the Royal College of Obstetricians and Gynaecologists' green-top guideline no.59 on hysteroscopy, best practice in outpatient, using techniques and equipment that minimise discomfort and pain.

Data source: Local data collection, for example benchmarked, patient-reported outcome measures including pain scores.

Process

Proportion of people with heavy menstrual bleeding and suspected submucosal fibroids, polyps or endometrial pathology who were offered outpatient hysteroscopy.

Numerator – the number in the denominator who were offered outpatient hysteroscopy.

Denominator – the number of people with heavy menstrual bleeding and suspected submucosal fibroids, polyps or endometrial pathology.

Data source: Local data collection, for example audit of patient records.

Outcome

Proportion of people with heavy menstrual bleeding and suspected submucosal fibroids, polyps or endometrial pathology who report satisfaction with outpatient hysteroscopy.

Numerator – the number in the denominator who report satisfaction with outpatient hysteroscopy.

Denominator – the number of people with heavy menstrual bleeding and suspected submucosal fibroids, polyps or endometrial pathology having outpatient hysteroscopy.

Data source: Local data collection, for example audit of patient records. The British Society of Gynaecological Endoscopy's outpatient hysteroscopy patient survey includes national data on patient satisfaction.

What the quality statement means for different audiences

Service providers (such as hospitals, primary care and community-based clinics) ensure that locally agreed referral pathways are in place to allow direct-access booking into one-stop diagnostic outpatient hysteroscopy services for people with heavy menstrual bleeding and suspected submucosal fibroids, polyps or endometrial pathology. Service providers ensure that the outpatient hysteroscopy procedure follows best practice guidelines. They organise regular audits that include patient‑reported outcomes benchmarked against local and national standards.

Healthcare professionals (such as gynaecologists, GPs and nurses) are trained to perform outpatient hysteroscopy procedures according to best practice guidelines, with techniques and equipment that minimise discomfort and pain. They advise people to take oral analgesia before the procedure and perform vaginoscopy as the standard diagnostic technique, using miniature hysteroscopes (3.5 mm or smaller). A member of staff acts as the person's advocate during the procedure to provide reassurance, explanation and support.

Commissioners (such as clinical commissioning groups and NHS England) ensure they commission outpatient hysteroscopy services for people with heavy menstrual bleeding and suspected submucosal fibroids, polyps or endometrial pathology that have clinical protocols in place to ensure adherence to best practice guidelines. Outpatient services may be delivered in community settings if they meet best practice guidelines.

People with heavy periods that may be related to other problems are offered a procedure called hysteroscopy, carried out in an outpatient hysteroscopy service. People having this procedure have a discussion with their healthcare professional about what this involves and possible alternatives, and are supported to make an informed choice about their care. A member of staff acts as the person's advocate during the procedure to provide reassurance, explanation and support.

Definition of terms used in this quality statement

Outpatient hysteroscopy

A procedure to examine the inside of the uterus. This is done by passing a thin telescope-like device, called a hysteroscope, that is fitted with a small camera through the neck of the womb (cervix). This procedure is done without general or regional anaesthesia. Vaginoscopy is the recommended technique and a miniature hysteroscope (3.5 mm or smaller) should be used. [Adapted from the Royal College of Obstetricians and Gynaecologists' outpatient hysteroscopy patient information leaflet]