Improving the gynaecology fast-track pathway
Catherine Allen, Calderdale and Huddersfield Foundation NHS Trust
Aim
The multidisciplinary gynaecology team including ultrasound were tasked with considering new ways of working to embrace the best practice timed pathway (BPTP) for gynaecology fast-track referrals to aid faster diagnosis and improve patient experience.
Method
The initial meeting of the clinical and non-clinical teams involved in all aspects of the patient pathway demonstrated a shared vision to improve both patient experience and performance. Prior to the introduction of the new system of work, patients were either seen in clinic or patients presenting exclusively with postmenopausal bleeding (PMB) were referred from primary care into a one-stop clinic. Retrospective audit showed that using ultrasound-acquired endometrial thickness measurement, approximately 40% of patients with PMB did not require hysteroscopy after initial ultrasound, which resulted in wasted appointments. A straight to test triage pathway was created to provide a streamlined approach, ensuring correct initial test, reduce unnecessary appointments and improve overall patient experience. Ultrasound provided ring-fenced appointments for straight-to-test patients. This was managed within existing radiology provision without any further resources or funding. The pathway was trialled initially over a 3-month period and is now in its 23rd month; at each review all teams worked together with a flexible approach to fine-tune new ways of working. Patient feedback has been monitored throughout via questionnaires.
Results
The number of patients first seen by ultrasound showed initial growth followed by maintenance, wasted hysteroscopy appointments reduced. Day 28 performance increased and has been met consistently since month 3 of trial (averaging 99%). Faster diagnosis standard performance from January 2022 has been consistently above 75%.
Conclusion
Creating a model of work using existing radiology provision in conjunction with implementing a multidisciplinary response to the gynaecology referrals has significantly improved the faster diagnosis standard for patients and improved patient experience.