Improving patient access through office hysteroscopy clinic redesign

Abstract

Background and objective: Patients with abnormal uterine bleeding (AUB) often require hysteroscopy as part of the diagnostic workup. The purpose of this study was to improve efficiency by shortening the time to patient appointment for office hysteroscopy. Interventions: Preintervention, nurse practitioners (NPs) and gynecologists saw patients with abnormal uterine bleeding (AUB) separately. This created inefficiency for the patients, frequently requiring second visits for hysteroscopy. A new hysteroscopy clinic was designed to increase practice efficiency. A collaborative team model was created including consecutive visits with NPs and gynecologists. Each patient with AUB was first evaluated by an NP, followed immediately by a shorter visit with a gynecologist for office hysteroscopy as indicated. NPs managed other diagnostic evaluation and bleeding treatment if hysteroscopy was not warranted. Collaborative clinic staffing consisted of two NPs seeing patients with AUB paired with one gynecologist for procedural support. Measurements and results: Electronic records of 393 patients scheduled for AUB visits from January to June 2015 were evaluated for preintervention data. Postintervention, 647 patient records were reviewed from January to June of 2016. During the preintervention period, 30% of patients had a hysteroscopy appointment scheduled within 0–13 days from the initial visit for AUB. Postintervention, the wait time for appointments decreased, with 63% of patients scheduled within 0–13 days. Clinic redesign also resulted in an increase of 57.5% in appointment slots. No-show rates and appointment fill rates were not adversely affected. Conclusions: A collaborative team-based care model using NPs and gynecologists improved efficiency and access to office hysteroscopy services.

Interventions to improve access to care for abnormal uterine bleeding: A systematic scoping review

“…Collectively, these studies suggested that 68%–89% of patients were evaluated and managed in the first one‐stop clinic visit. A collaborative hysteroscopy clinic with women's health nurse and gynecologist improved service “availability” by increasing the number of appointment slots by more than 50% and reducing the waiting time for appointments 12 . A prospective study, that interviewed 22 women with AUB, confirmed that a one‐stop clinic was suited to the needs of these women 16 .…”

“…Following title screening, we included 314 records, which was reduced to 91 after abstract screening. After full‐text screening, 21 papers 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 were included. Two papers 29 , 30 were from one study, so the total number of included studies was 20.…”

“…appointments. 12 A prospective study, that interviewed 22 women with AUB, confirmed that a one-stop clinic was suited to the needs of these women. 16 A general practitioner-led "Bridges pathway" for access to appropriate secondary care showed improvements in getting choice of appointment slot, choice of doctor, and coordination between primary and secondary care.…”

“…28 One study recruited grade 9 girls from a school setting. 32 There were 10 experimental studies, including three quasiexperimental studies 12,25,32 and seven randomized controlled studies. 20,21,24,[27][28][29]31 There were five prospective studies [15][16][17]19,26 and six retrospective studies.…”

Prediction of Factors Associated with Abnormal Uterine Bleeding by Transvaginal Ultrasound Combined with Bleeding Pattern

“…A total of 205 patients with abnormal uterine bleeding admitted to hospital from February 2020 to February 2022 were selected as experimental subjects, and the patients were aged from 30 to 65 years old. According to the corresponding diagnostic criteria of endometrial polyp, endometrial hyperplasia, and endometrial cancer [ 13 , 14 ], 205 patients were divided into the endometrial polyp group (56 cases), endometrial hyperplasia and canceration group (84 cases), and normal cycle endometrial group (65 cases). General data of patients were collected, and related factors were analyzed.…”