Benefits of Office / Ambulatory Gynaecology

by DR JOHN BARKER Bsc MBBS MRCOG, Dip (Risk Management). Obstetrician/ Gynaecologist at Arnos Vale Medical Center.

AMBULATORY GYNAECOLOGY is where procedures normally done in hospital are done in an outpatient/office setting. This shift decreases waiting times from diagnosis to treatment and is cost effective for the patient and has widely been accepted in gynaecological practice.

The consultation, investigation and treatment in some cases can be carried out in a single patient visit with the advantages being avoidance of sedation or general anaesthesia and is associated with quicker recovery times.

The advantages include: Improving Organisation and streamlining of care, these include: 1.

Clinics organised according to clinical symptoms rather than general gynaecology clinics for example in a Post-menopausal Bleeding Clinic , patients with this symptom can come to a specialised clinic be investigated, with a trans- vaginal scan and access to immediate out-patient hysteroscopy(camera in the womb)and biopsy. 2. The Gynaecologist can “see and treat” at the same time allowing for a shorter period between the diagnosis and treatment 3. Ability to make treatment plans quicker because diagnostic procedures can be done faster in office or in an outpatient setting allowing shorter diagnosis times.

Cost effectiveness 1. Services like out-patient hysteroscopy are associated with significant cost savings for the patient, employer and insurance companies as it is done without sedation or general anaesthesia and does not require theatre time. one can get this procedure and immediately go back to work within a 24hr time period, this has a saving of up to $6000.00 initially if done in an outpatient setting/office and the savings increase more as time off from work is minimised.

Other Advantages include:

Σ Quicker recovery and return to work family life

Σ Reduction of hospital and theatre waiting times

Σ Reduction of hospital elective surgeries

Σ Improving patient experience Procedures that are moved to an ambulatory/office setting: Outpatient Hysteroscopy

This is a diagnostic procedure that looks inside of the womb with a camera with minimal or no discomfort

Resection of Fibroids/polyps

This procedure removes fibroids/polyps in the lining of the womb and can be carried out on an outpatient basis

Endometrial Ablation for heavy menses

Endometrial Ablation procedure destroys the lining of the womb which results in either no period or greatly reduced periods

Outpatient Hysteroscopy and Endometrial Biopsy

Is a visualisation of the uterine womb cavity using the method of the Hysteroscope and taking a biopsy

Suction Curettage

Also known as womb scrape using a Manual Vacuum Aspirator (small syringe) to clean the uterus for miscarrige. This procedure is carried out using simple analgesia and a local anaesthesia avoiding the need for sedation or general anaesthesia.

Drainage of Bartholin’s and Labial abscesses

This procedure can be safely and effectively done in an outpatient setting

Colposcopy

A colposcope is used for this procedure and is used to look at the neck of the womb In conclusion gynaecology has evolved to the point where most of the procedures done in hospital can be done in an outpatient setting or an office and the major advantages are for the patient as it is associated with quicker recovery times and return to normality and cost savings.