Background Subdermal implants (SDI) are cost effective when used for the recommended time. Early removal of SDI reduces cost effectiveness and we were aware anecdotally that this was an issue within our service. Data was lacking however. Subsequently removal rates at 3 and 6 months have been included within our Public Health Quality Contract (PHQC). Various strategies were implemented to reduce early removal. These included: improving the consent process by amending consent form; encouraging the use of additional methods to manage unscheduled bleeding; starting a dedicated implant removal clinic in February 2014.

Aim Have the outlined service changes impacted on SDI removal rates?

Methods Data from our PHQC was obtained from 2014–15. This measured SDI removal rates as a proportion of the total SDI fitted by our service.

Results In April 2014 the 3 months removal rate was 3.53%. By November 2014 it had fallen to 0.34%.

Discussion The strategies that were implemented appear to have had the desired effect. Care was taken to ensure staff gave patients the right information prior to fitting to ensure that their expectations of how any side effects would be managed was clear at the outset. The implant removal clinics were initially slow to get established and now are fully booked for months in advance. This has led to some criticism that patients are now unable to get their implants removed easily. The challenge moving forward is to ensure that patients have any symptoms managed promptly whilst keeping retention rates high.