Nishita Mehta
Introduction
Referrals for suspected endometrial cancer continue to rise, placing increasing pressure on hysteroscopy services to deliver timely diagnosis while meeting the NHS Fast Diagnostic Standard. Hysteroscopy remains central to the assessment of postmenopausal bleeding. This project evaluated the two-week wait hysteroscopy pathway across the South East London network following service changes to expand outpatient capacity.
Methods
A retrospective re-audit was conducted between January and March 2025 across five hospitals, following a 2024 audit cycle. Data were analysed for 674 patients referred via the two-week wait pathway. Outcomes included outpatient hysteroscopy utilisation, time to investigation and time to discharge. Cross-site benchmarking was used to identify variation and inform service improvements.
Results
Outpatient hysteroscopy increased from 52% to 66% (27% relative increase), reducing reliance on theatre-based procedures. Median time to outpatient hysteroscopy improved from 27 to 18 days, and to general anaesthesia hysteroscopy from 35 to 24 days.
Median time to discharge improved from 35 to 16 days following clinic sampling and from 42 to 23 days following outpatient hysteroscopy. Overall, 69.6% of patients were discharged within 28 days. Failed outpatient hysteroscopy (15%) remained the main cause of delay, with median discharge at 49 days.
Conclusion
Expanding outpatient hysteroscopy improved pathway efficiency and reduced theatre dependency. Variation across sites highlighted opportunities for standardising patient selection, counselling and analgesia to reduce outpatient failure.
Authors
Nishita Mehta, Guys and St Thomas Hospital Trust, London, United Kingdom
Laura Onwubalili, King's College Hospital Trust, London, United Kingdom