{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T13:37:11Z","timestamp":1775914631103,"version":"3.50.1"},"reference-count":17,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"unspecified","delay-in-days":56,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Qual"],"accepted":{"date-parts":[[2025,7,23]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Referrals for postmenopausal bleeding (PMB) were creating a pressure point within a general gynaecology outpatient clinic in NHS Forth Valley (NHSFV) in Scotland. This project originated in concerns around delays in time from referral to diagnosis as a result of this pressure point.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>The aim of this project was to test the efficiency of a process change which reduced waiting time from referral to diagnosis for patients with PMB.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Use Active Clinical Referral Triage (ACRT) and a one-stop clinic to reduce waiting lists. Quality improvement methods including data collection and process mapping were used to understand the current system. Cycles of the Plan-Do-Study-Act (PDSA) tool were applied to test the concept of introducing a one-stop clinic for PMB.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Qualitative data gathered during the project showed that patients preferred the one-stop clinic. Limited quantitative data indicated the one-stop clinic design reduced PMB referral waiting time for patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our aim was to streamline a process to reduce waiting time between referral and diagnosis for patients with PMB. This was achieved by the creation of a one-stop clinic for PMB\/unscheduled bleeding on HRT (hormone replacement therapy) patients. The work to date has highlighted the efficiency of the new process and ultimately suggests the potential for a reduction in waiting times in this pathway.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjoq-2024-003248","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T14:20:24Z","timestamp":1756218024000},"page":"e003248","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["A one-stop clinic improvement project for postmenopausal bleeding in NHS Forth Valley"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0259-3667","authenticated-orcid":false,"given":"Andrew","family":"Robinson","sequence":"first","affiliation":[{"name":"Improving Access Portfolio, Healthcare Improvement Scotland, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donald","family":"Wilson","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynaecology, Forth Valley Royal Hospital, Larbert, Falkirk, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawn","family":"Mahal","sequence":"additional","affiliation":[{"name":"Evidence and Evaluation for Improvement, Healthcare Improvement Scotland, Edinburgh, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"2025082607200562000_14.3.e003248.1","unstructured":"World health organization . Menopause. 2024. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/menopause"},{"key":"2025082607200562000_14.3.e003248.2","unstructured":"Scottish Intercollegiate Guidelines Network . Investigation of post-menopausal bleeding: a national clinical guideline. Guideline 612002."},{"key":"2025082607200562000_14.3.e003248.3","unstructured":"Scottish Government . Cancer waiting times. What are the cancer waiting time standards? Public Health Scotland; 2012."},{"key":"2025082607200562000_14.3.e003248.4","doi-asserted-by":"publisher","DOI":"10.1093\/fampra\/cmy069"},{"key":"2025082607200562000_14.3.e003248.5","doi-asserted-by":"publisher","DOI":"10.1136\/jfprhc-2012-100549"},{"key":"2025082607200562000_14.3.e003248.6","doi-asserted-by":"publisher","DOI":"10.1080\/0144361031000074763"},{"key":"2025082607200562000_14.3.e003248.7","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1111\/1471-0528.16431","article-title":"Implications for the future of Obstetrics and Gynaecology following the COVID\u201019 pandemic: a commentary","volume":"127","author":"Kasaven","year":"2020","journal-title":"BJOG"},{"key":"2025082607200562000_14.3.e003248.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2015-004411"},{"key":"2025082607200562000_14.3.e003248.9","unstructured":"NHS Scotland . NHS scotland waiting times guidance: november 2023. 2023. Available: https:\/\/www.gov.scot\/publications\/nhsscotland-waiting-times-guidance-november-2023\/pages\/8"},{"key":"2025082607200562000_14.3.e003248.10","unstructured":"Wood M , Rymaszewski L , McDonald D , et al . Active Clinical Referral Triage (ACRT) &amp; Discharge Patient Initiated Review (PIR) Toolkit. 2021."},{"key":"2025082607200562000_14.3.e003248.11","unstructured":"Scottish Access Collaborative . Case study: university hospital hairmyres (uhh) gastroenterology team. Healthcare Improvement Scotland; 2020."},{"key":"2025082607200562000_14.3.e003248.12","doi-asserted-by":"crossref","first-page":"193","DOI":"10.4997\/jrcpe.2019.305","article-title":"The safety of using active triage to provide advice rather than a face-to-face neurology outpatient appointment","volume":"49","author":"Bennett","year":"2019","journal-title":"J R Coll Physicians Edinb"},{"key":"2025082607200562000_14.3.e003248.13","doi-asserted-by":"crossref","DOI":"10.1016\/j.bjoms.2023.08.083","article-title":"P012 Active clinical referral triage for routine temporomandibular joint referrals to OMFS in a District General Hospital","volume":"61","author":"Potter","year":"2023","journal-title":"British Journal of Oral and Maxillofacial Surgery"},{"key":"2025082607200562000_14.3.e003248.14","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2003.024489"},{"key":"2025082607200562000_14.3.e003248.15","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2006.092098"},{"key":"2025082607200562000_14.3.e003248.16","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-10-0832"},{"key":"2025082607200562000_14.3.e003248.17","unstructured":"British Society for Gynaecological Endoscopy . Outpatient hysteroscopy - patient satisfaction survey (oph-pss). Available: https:\/\/www.bsge.org.uk"}],"container-title":["BMJ Open Quality"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjoq-2024-003248","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T14:20:27Z","timestamp":1756218027000},"score":1,"resource":{"primary":{"URL":"https:\/\/qir.bmj.com\/lookup\/doi\/10.1136\/bmjoq-2024-003248"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":17,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,8,26]]},"published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1136\/bmjoq-2024-003248"],"URL":"https:\/\/doi.org\/10.1136\/bmjoq-2024-003248","relation":{},"ISSN":["2399-6641"],"issn-type":[{"value":"2399-6641","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]}}}