Audit of a new one-stop menstrual disorder service

Objective To evaluate che outcomes of a one-stop menstrual disorder clinic and to determine its acceptability to patients. Design A two-part audit including a retrospective analysis of data from pat ients' records, and a prospective study of patients' views of the service. Setting The Birmingham Women's Hospital, Birmingham, UK. Subjects and methods Audit I involved a manual and computer-assisted search of the records of patients who attended between 1 May and 31 October, 1990 , fur data collection and retrospective analysis. Audit II was based on the replies to anonymous printed questionnaires, completed after the consultat ion, by patients who attended the clinic between 1 January and 31 March 199 7. Results Audit I: A total of 188 records (95%) were traced and audited. The mean waiting time to consultation was 5.5 weeks, The most common indication for patient referral was postmenopausal bleeding (PMB) (32.2%), followed b y intermenstrual bleeding (30.5%) and menorrhagia (12.6%), a combination of which was most prevalent among women aged 41-50 years (90.7%). Out-patient hysteroscopy was successful in 92.6% of patients. The most common patholog y was an endometrial polyp. There were two cases of endometrial carcinoma. Additional procedures at a later stage under general anaesthetic were neede d by 25 patients. The difference in costs over 6 months between the out-pat ient one-stop service and the traditional referral system following in-pati ent treatment was pound 31 000. Audit II: Although nine out of every 10 pat ients experienced moderate discomfort, there was overwhelming patient satis faction with all aspects of the service. Conclusion The one-stop out-patient service is successful, rapidly accessib le, safe and convenient, and is more cost-effective than the service offere d through the traditional referral system. Our study also indicates that th e service is applicable to other gynaecological problems, such as assessmen t of the endometrium as part of the investigation for infertility.