Outpatient Hysteroscopy/Biopsy - Pain control and Patient Choice

The request was partially successful.

Katharine Tylko-Hill

Dear Brighton and Sussex University Hospitals NHS Trust,

Under the Freedom of Information Act (2000) please would you supply
the following information relating to your Trust’s practice of
OUTPATIENT HYSTEROSCOPY/BIOPSY – PAIN CONTROL AND PATIENT CHOICE

1. The patient information leaflet/s
2. The consent form/s
3. The surgical protocol/s
4. Does the leaflet advise the patient to ask her GP to prescribe
gynae-specific painkillers to be taken BEFORE the procedure - Y/N?
5. What type and dose of painkillers does your Trust advise
patients to take before the procedure?
6. Are ALL your hysteroscopy/biopsy patients given the following
choices BEFORE the procedure is attempted:
a) General Anaesthesia – Y/N?
b) spinal anaesthesia – Y/N?
c) conscious sedation – Y/N?
7. For each of the last 3 financial years, how many of your
hysteroscopy/biopsy patients had
a) GA with overnight stay?
b) GA day-case ?
c) spinal anaesthesia?
d) conscious sedation?
e) local anaesthetic?
f) no anaesthetic?
8. What width hysteroscopes do you use? Rigid or flexible?
9. What % patients DNA outpatient hysteroscopy/biopsy?
10. What % OP hysteroscopy/biopsy patients had a failed procedure
that had to be repeated with epidural, GA or conscious sedation?
11. All audits of adverse events, e.g. infection, perforation.
12. All surveys of patients’ experiences.

Yours faithfully,

Katharine Tylko-Hill
Macmillan CancerVOICE

Gustafson, Roger,

Dear Katharine Tylko-Hill

I am writing to acknowledge your request for information under the Freedom
of Information (FOI) Act. Your request was received in our office on:
18/11/2013

We are considering your request and will reply more fully in due course.
Under the Freedom of Information Act, we have 20 working days in which to
respond.

Some information, however, might be withheld due to exemptions which are
allowed for by the Act. If this is the case, we will tell you that we have
withheld information and why.

If we can be of any further assistance to you in the meantime, please do
not hesitate to contact the Trust at: [1][BSUH request email]

Brighton and Sussex University Hospitals NHS Trust will make every effort
to respond to your request if possible. Our main aim and priority,
however, is to provide the best care possible to our patients. Our Trust
will not respond to any requests which are designed to distract staff from
their responsibilities. We appreciate your understanding.

Yours sincerely

Freedom of Information Office

Brighton and Sussex University Hospitals NHS Trust

References

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Dear Katharine Tylko-Hill

Thank you for your recent request for information under the Freedom of
Information (FOI) Act 2000 regarding “Outpatient Hysteroscopy/Biopsy”.

Our staff are currently looking into what information the Trust holds in
response to your request.  Due to limitations in the relevant recording
systems, we are having to research patient notes across several sites and
this process is taking longer than expected.  We would therefore
appreciate an additional 20 working days to consider your request and
prepare our response.  The Trust will aim to respond to your request on or
before 10 January 2014.

We regret any inconvenience caused by this delay.

In the meantime, if we can be of further assistance please do not hesitate
to contact the Trust at: [1][BSUH request email]

Yours sincerely

Freedom of Information Office

Brighton and Sussex University Hospitals NHS Trust

 

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2 Attachments

Dear Katharine Tylko-Hill,

 

Thank you for your recent request for information under the Freedom of
Information (FOI) Act 2000.

 

We are now in a position to respond to your request.

 

Your request:

 

Under the Freedom of Information Act (2000) please would you supply the
following information relating to your Trust’s practice of OUTPATIENT
HYSTEROSCOPY/BIOPSY – PAIN CONTROL AND PATIENT CHOICE.

 

1. The patient information leaflet/s

2. The consent form/s

3. The surgical protocol/s

4. Does the leaflet advise the patient to ask her GP to prescribe
gynae-specific painkillers to be taken BEFORE the procedure - Y/N?

5. What type and dose of painkillers does your Trust advise patients to
take before the procedure?

6. Are ALL your hysteroscopy/biopsy patients given the following choices
BEFORE the procedure is attempted:

a) General Anaesthesia – Y/N?

b) spinal anaesthesia – Y/N?

c) conscious sedation – Y/N?

7. For each of the last 3 financial years, how many of your
hysteroscopy/biopsy patients had

a) GA with overnight stay?

b) GA day-case ?

c) spinal anaesthesia?

d) conscious sedation?

e) local anaesthetic?

f) no anaesthetic?

8. What width hysteroscopes do you use? Rigid or flexible?

9. What % patients DNA outpatient hysteroscopy/biopsy?

10. What % OP hysteroscopy/biopsy patients had a failed procedure that had
to be repeated with epidural, GA or conscious sedation?

11. All audits of adverse events, e.g. infection, perforation.

12. All surveys of patients’ experiences.

 

Our response:

 

1.     A patient information leaflet is given to all women prior to having
a hysteroscopy procedure – see attached.

 

2.     A consent form is signed by the patient in advance of having a
hysteroscopy procedure – see attached.

 

3.     The removal of endometrial polyps & resection of small submucous
fibroids is carried out in the same set-up of outpatient hysteroscopy.
Ablation of the endometrium using Novasure is done for patients who have
heavy periods when indicated.  Also, the removal of IUCD/IUS including
retrieval of missing devices, insertion of IUCD/IUS, removal of cervical
polyps & cauterisation of the cervix are carried out when required.

 

4.     No

 

5.     The type and dose of painkillers dependants whether the patient is
undergoing treatment or a diagnostic procedure.

 

      Treatment: 100mg Diclosenac PR, 30mg Codeine oral, 1g IV Paracetamol

      Novasure: 100mg Diclofenac ac, 5-10mg  Oramoph/200 mcg Fentanyl
lozenge as required, 1g IV paracetamol, local anaesthetic inflitration
(Lignospam)

      Diagnostic: local anaesthetic infiltration (Lignospam)

 

6.     As follows:

a) General anaesthesia - Yes

            b) Spinal anaesthesia - Yes  (Not generally offered other than
in exceptional circumstances)

            c) Conscious sedation - Yes

 

7.     This information is not centrally held by the Trust and would
involve considerable research to source this information.  Such an
endeavour would exceed the maximum allowable time period under the Act,
thus s.12 exemption would apply.  We have however, provided information
regarding patients who had a hysteroscopy/biopsy as a day case or
overnight admission – see table below:

 

  2010/2011 2011/2012 2012/2013
  DC IP DC IP DC IP
General anaesthetic 281 12 253 14 139 4
Local anaesthetic 4 0 8 0 4 0
23
None recorded 68 59 18 78 15
 
Other anaesthetic 2 0        
Spinal anaesthesia 1 1        

 

           

8.     Both flexible and rigid hysteroscopes are used.  Width is between
1.8 to 5mm diameter. 

 

9.     In 2012/2013, the DNA rate for outpatient hysteroscopy was 2.3%.

 

10.  This information is not centrally held by the Trust and would involve
considerable research to source this information.  Such an endeavour would
exceed the maximum allowable time period under the Act, thus s.12
exemption would apply. 

 

Brighton and Sussex University Hospitals NHS Trust has studied the work
involved in processing your request for information and has estimated that
the cost of complying with this would exceed the appropriate limit as set
out in the Freedom of Information and Data Protection (Appropriate Limit
and Fees) Regulations 2004. The limit set down by the regulations for
public authorities is £450, which amounts to a maximum of 18 hours of
search and retrieval time charged at £25.00 per hour, the hourly rate also
specified in the regulations.

 

BSUH NHS Trust considers that it would take in excess of 18 hours to
retrieve and extract the information in the format that you have
requested. Subsequently, it would cost the Trust more than £450, the limit
specified in the regulations. Under section 12 of the Freedom of
Information Act, BSUH NHS Trust is therefore not obliged to provide the
information that you have requested.

 

11.  The Trust has not undertaken an audit of adverse events specific to
your request.  Since the Trust does not hold this information, it is not
available under FOIA.

 

12.  No recent surveys have been completed specifically for
hysteroscopy/biopsy procedures.  Since the Trust does not hold this
information, it is not available under FOIA.

 

Please note that any information provided by this Trust is for your
personal use and not for resale or use for profit in any way under the
Re-use of Public Sector Information Regulations 2005.

 

If you require clarification or if we can be of any further assistance to
you, please do not hesitate to contact us at: [1][BSUH request email]

 

If you are dissatisfied with the outcome of your enquiry, you have the
right to appeal. The address of our FOI Review Department is:

 

Brighton and Sussex University Hospitals NHS Trust
FOI Review
Central Information Unit - D Block
Brighton General Hospital
Elm Grove
Brighton BN2 3EW

 

If you are still not satisfied with the outcome of your appeal, you can
write to:

 

The Information Commissioner
Wycliffe House
Water Lane
Wilmslow
Cheshire SK9 5AF
Telephone: 01625 545700

 

We hope that you find the information provided helpful.

 

Yours sincerely

 

Freedom of Information Office

Brighton and Sussex University Hospitals NHS Trust

 

References

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