title: The delivery of heavy menstrual bleeding services in England and Wales after publication of national guidelines: a survey of hospitals.
abstract: BACKGROUND
  In 2007-2008, two UK-based organisations, the National Institute for Health and Clinical Excellence and the Royal College of Obstetricians and Gynaecologists, published guidelines for the management of care and organisation of outpatient services for women with heavy menstrual bleeding (HMB). In 2010, this study was conducted to provide an update on guideline-related services provided in England and Wales, and whether they are consistent with national clinical guidelines two to three years after publication.
  
  
  METHODS
  An organisational survey of outpatient gynaecology clinics was conducted of 221 hospitals in 154 acute National Health Service (NHS) trusts in England and Wales. A questionnaire was distributed to all hospitals to examine provision of diagnostic and therapeutic services in outpatient settings. Descriptive statistics were used to summarize results.
  
  
  RESULTS
  The response rate was 100%. For diagnosis, 80% of hospitals had ultrasound, 87% had hysteroscopy, and 98% had endometrial biopsy available. Overall, 76% of hospitals provided an information leaflet, 8% referred patients to a website for information, and 20% did not provide any written information. A dedicated menstrual bleeding clinic was present in 38% of hospitals. Only 30% of hospitals reported that they have a local written protocol regarding the care and management of women with HMB.
  
  
  CONCLUSIONS
  The majority of hospitals offer appropriate diagnostic and surgical services for women with HMB. However, local protocol development may not reflect the local services. It may be that hospitals are finding it difficult to summon resources to provide clinics for women with menstrual disorders.
authors.affiliation: Center for Healthcare Studies, Northwestern University, 420 E Superior St, 10th Floor, Chicago, IL 60611, USA. suzanne.cox@northwestern.edu.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Cox
authors.forename: David
authors.initials: D
authors.lastname: Cromwell
authors.forename: Tahir
authors.initials: T
authors.lastname: Mahmood
authors.forename: Allan
authors.initials: A
authors.lastname: Templeton
authors.forename: Benedetta
authors.initials: B
authors.lastname: La Corte
authors.forename: Jan
authors.initials: J
authors.lastname: van der Meulen
mesh_terms: D000553:Ambulatory Care / Q000592:standards / Q000706:statistics & numerical data; D002985:Clinical Protocols / Q000592:standards; D004739:England; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008595:Menorrhagia / Q000175:diagnosis / Q000628:therapy*; D009775:Obstetrics and Gynecology Department, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D014852:Wales