Noor ul Huda

Title: Enhancing the Referral and Management Pathway of Postmenopausal Bleeding in Women Not on Hormone Replacement Therapy: A Quality Improvement Programme

Abstract

Background: Postmenopausal bleeding (PMB) accounts for a significant proportion of urgent gynaecological referrals and requires timely investigation to exclude endometrial malignancy. Despite existing Trust protocols, gaps were identified in referral appropriateness, triage efficiency, and compliance with national standards. This Quality Improvement Programme (QIP) aimed to streamline the PMB pathway for women not on hormone replacement therapy (HRT) and enhance adherence to National guidelines.

Aim: To improve compliance with the Trust PMB pathway through protocol optimisation, enhanced triage communication, and data-driven pathway redesign.

Methods: A two-cycle QIP was conducted in the Department of Obstetrics and Gynaecology. The first audit assessed compliance with Trust PMB V6 against National Standards.

Data were collected retrospectively from referrals, imaging reports, and histology records. Identified deficiencies led to multidisciplinary interventions including:

• Introduction of PMB V7 (non-HRT) and V1 (HRT) protocols,

• Development of a live ultrasound triage spreadsheet accessible on Microsoft Teams,

• Enhanced 2-week-wait (2WW) triage guide and ERS-based communication system. A re-audit post-intervention measured improvement in pathway efficiency and compliance.

Results: Initial compliance with TVS prior to referral was only 18%, and delays were observed in achieving first contact within 2 weeks and diagnosis within 28 days. Postintervention, compliance improved substantially:

• 100% first contact within 2 weeks,

• Full compliance for non-intervention cases,

• Marked improvement in triage accuracy and communication efficiency.

Minor delays persisted for hysteroscopy scheduling, identified as the next focus for improvement.

Conclusion: Targeted protocol revision and digital triage optimisation significantly improved pathway efficiency, compliance with national standards, and patient experience in PMB management. This QIP demonstrates that structured, multidisciplinary, datadriven interventions ca