A HSE national review into the diagnosis timeline of endometrial cancers, conducted in 2020, identified “a number of cases” where diagnosis was “delayed for over one year”, the Executive stated. Enquiries showed there were “extenuating circumstances to explain the delay in the majority of cases. In <5 cases, where there were no extenuating circumstances, this had been acknowledged prior to the review and open disclosure had taken place.”
On foot of the analysis, interim guidance on the management of post-menopausal bleeding (PMB) has been operational since August 2020 and “definitive guidance” is currently in development.
The HSE analysis took place following cases of delayed diagnosis of endometrial cancer at Letterkenny University Hospital (LUH). An external review commissioned by Saolta, published in 2020, found poor follow-up practices in the referral, assessment, and diagnosis processes for women referred to LUH’s gynaecology services with PMB; increasing waiting lists that impacted on timely access to services; poorly defined and inefficient care pathways; and an overall poor approach to the governance and oversight of gynaecology services at the hospital.
In October, HIQA stated it was “not assured” there were sufficient and effective governance and oversight arrangements in place to assure the quality and safety of the gynaecology service in LUH, after conducting an extensive review.
According to HIQA’s review, the HSE’s preliminary analysis of endometrial cancer diagnosis timelines nationally suggested that “similar historic challenges with timely access to diagnosis may have occurred in other hospitals” in the absence of “defined best practice standards for the timely diagnosis of endometrial cancer”.
Meanwhile, national key performance indicators (KPIs) for ambulatory gynaecology “have been finalised and the first set of data is due for return” at the end of April, according to the HSE.
“The first national KPIs developed [for gynaecology] were the PMB KPIs. Future KPIs will be developed in the areas of fertility, endometriosis, and women’s health physiotherapy.”