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Analysis of an innovative one-stop, hospital-based, outpatient acute gynaecology clinic: model for taking the service to community
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  1. Vinod Kumar1,
  2. Janesh Gupta2,
  3. Manjeet Shehmar3
  1. 1CSRH Trainee, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2Professor, Department of Obstetrics and Gynaecology, Birmingham Women's NHS Foundation Trust, Birmingham, UK
  3. 3Consultant in Obstetrics and Gynaecology, Birmingham Women's NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Manjeet Shehmar, Department of Obstetrics and Gynaecology, Birmingham Women's NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2TG, UK; Manjeet.Shehmar{at}bwhct.nhs.uk

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Introduction

Community Sexual and Reproductive Healthcare (CSRH) consultants working closely with general practitioners (GPs) and hospital consultants can offer patients a responsive, efficient, one-stop gynaecology service in the community.

We present a retrospective analysis of outcomes of consultations in 914 patients attending a new model acute gynaecology clinic (AGC) at Birmingham Women's Hospital, Birmingham, UK over a 24-month period between July 2010 and June 2012.

What is the clinic?

The AGC is a ‘one-stop’ ‘see and treat’ service for acute gynaecology conditions for patients with severe menorrhagia, irregular vaginal bleeding, pelvic pain, and postoperative complications with symptom duration between 48 hours and 2 weeks. The philosophy is based on the premise that not all urgent gynaecology problems need immediate assessment. Where such assessments can be made by an appropriately skilled senior clinician, using suitable diagnostic tools, unnecessary hospital admission and delays in treatment can result in improved patient safety and experience.

Why was a new approach to managing gynaecology patients needed?

A key government National Health Service (NHS) reform objective is to reduce waiting times for specialist care and improve the quality of care and patient experience.1–3 Additionally, the Royal College of Obstetricians and Gynaecologists (RCOG) Standards for Gynaecology 2008 recommend that relevant gynaecology patients should have prompt access to emergency care including diagnostic resources such as ultrasound scanning, and should be reviewed by a consultant within 24 hours of presentation.4

A local audit indicated that a consultant reviewed only 35% of patients within the first 24 hours of admission, whereas 58% of patients never saw a consultant. Furthermore, over 50% of admissions stayed in for longer than 24 (range 18–72) hours, and the main reason for delayed discharge was waiting for an ultrasound scan (65%). This indicated …

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