Development of a New Pathway during Covid Pandemic to Reduce the Waiting List in Hysteroscopy Clinic

To develop an efficient and practical pathway to reduce the waiting list for outpatient hysteroscopy in patients with post menopausal bleeding. The clinical data was retrospectively analysed in Welsh Clinical Portal of 1339 patients who were referred for hysteroscopy as urgent suspected cancer over a period of 12 months (1st January to 31st December 2019) in Hywel DDA University Health Board in Wales, United Kingdom. A total of 1339 patients were referred for hysteroscopy over 12 months. Among them 133 patients underwent hysteroscopy for evaluation of PMB despite ET being less than 4 mm; 1.50% patients were on tamoxifen and 16.45% were on HRT. Biopsy was taken for 86.00% of patients. Among them 1.50% were reported as malignant, 72.00% benign and 9.80% as insufficient sample. Patients with PMB and ET less than 4 mm and without suspicious features on ultrasound and who are without clinical risk factors can be reviewed virtually (in virtual clinics) by consultants or senior doctor and can be discharged. They should be instructed to report back if they experience persistent bleeding and then they would need hysteroscopy for further evaluation.