Outpatient hysteroscopy/biopsy - RCOG/BSGE 2018 statement on Pain Control and Patient Choice

The request was successful.

Katharine Tylko-Hill

Dear East Suffolk and North Essex NHS Foundation Trust,

Under the Freedom of Information Act please may I have answers to the following questions. This request is to audit implementation of the RCOG/BSGE statement about choice and pain-relief in hysteroscopy.

1. a) Have your hysteroscopists read the following statement issued by the RCOG in December 2018 - Y/N?
b) Have your hysteroscopy managers read the following statement – Y/N?
https://www.rcog.org.uk/en/guidelines-re...
The British Society for Gynaecological Endoscopy published this statement in December 2018:
"Diagnostic hysteroscopy is a commonly performed investigation; it is safe and of short duration. Most women are able to have the procedure in an outpatient setting, with or without local anaesthesia, and find it convenient and acceptable. However, it is important that women are offered, from the outset, the choice of having the procedure performed as a day case procedure under general or regional anaesthetic. Some centres are also able to offer a conscious sedation service in a safe and monitored environment. It is important that the procedure is stopped if a woman finds the outpatient experience too painful for it to be continued. This may be at the request of the patient or nursing staff in attendance, or at the discretion of the clinician performing the investigation."
________________________________________

2. Please are ALL your hysteroscopy patients from the outset routinely offered the choice of having hysteroscopy as a day case procedure a) under GA – Y/N? b) under regional anaesthetic – Y/N? c) with IV sedation?

3. Do your hysteroscopy consent forms contain tick-boxes to enable a patient to choose a) GA – Y/N? b) regional anaesthesia – Y/N? c) IV sedation – Y/N?

4. Have all your outpatient hysteroscopy teams received written instruction to monitor the patient throughout the procedure, to ask if she is experiencing pain, and to stop if the patient asks or is showing signs of severe pain or distress – Y/N?

5. Do all your hysteroscopy clinics routinely record ALL patients’ VAS pain-scores a) as hysteroscope passes through the cervix – Y/N, b) at biopsy – Y/N?

6. Does your hysteroscopy department send all its patients the RCOG’s Patient Information Leaflet, published on its website - Y/N? https://www.rcog.org.uk/en/patients/pati...

7. Does your hysteroscopy department intend to start using the RCOG leaflet – Y/N? If so, in which month/year?

8. If your hysteroscopy department uses its own Patient Information Leaflet, please may I have a link to it?

9. Does the leaflet include ALL the key points listed (below) by the RCOG – Y/N?
Key points
• Outpatient hysteroscopy (OPH) is a procedure carried out in the outpatient clinic that involves examination of the inside of your uterus (womb) with a thin telescope.
• There are many reasons why you may be referred for OPH, such as to investigate and/or treat abnormal bleeding, to remove a polyp seen on a scan or to remove a coil with missing threads.
• The actual procedure usually takes 10–15 minutes. It can take longer if you are having any additional procedures.
• You may feel pain or discomfort during OPH. It is recommended that you take pain relief 1–2 hours before the appointment.
• If it is too painful, it is important to let your healthcare professional know as the procedure can be stopped at any time.
• You may choose to have the hysteroscopy under general anaesthetic. This will be done in an operating theatre, usually as a daycase procedure.
• Possible risks with hysteroscopy include pain, feeling faint or sick, bleeding, infection and rarely uterine perforation (damage to the wall of the uterus). The risk of uterine perforation is lower during OPH than during hysteroscopy under general anaesthesia.

Yours faithfully,

Katharine Tylko-Hill

FOI Requests CGH, East Suffolk and North Essex NHS Foundation Trust

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From 1st July 2018, Ipswich and Colchester Hospitals merged to become East
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Amy Witham

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East Suffolk and North Essex NHS Foundation Trust

Email: [1][East Suffolk and North Essex NHS Foundation Trust request email]

 

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FOI Requests CGH, East Suffolk and North Essex NHS Foundation Trust

From 1^st July 2018, Ipswich and Colchester Hospitals merged to become
East Suffolk and North Essex NHS Foundation Trust. Therefore, unless
otherwise specified, responses are on behalf of East Suffolk and North
Essex NHS Foundation Trust.

 

Thank you for your recent enquiry regarding information held by the East
Suffolk and North Essex NHS Foundation Trust:

 

Your enquiry has been dealt with in accordance with the Trust’s Freedom of
Information Act 2000 Policy and Procedures. We are pleased to enclose the
information you requested:

 

Under the Freedom of Information Act please may I have answers to the
following questions.  This request is to audit implementation of the 
RCOG/BSGE statement about choice and pain-relief in hysteroscopy. 

 

1)      Have your hysteroscopists read the following statement issued by
the RCOG in December 2018 - Y/N?

a.       Have your hysteroscopy managers read the following statement

We do not have hysteroscopy managers specifically, but relevant personnel
are aware of this statement. However, this is a statement from the BSGE
and not National guidance.

The link provided in the quote is to the RCOG Green top guideline for best
practice in Hysteroscopy and was written in 2011. It is our understanding
that the second edition of this guideline is in development.

We follow national guidance and best practice recommendation for
Hysteroscopy

 

2)      Are ALL your hysteroscopy patients from the outset routinely
offered the choice of having hysteroscopy as a day case procedure:  

a.       under GA – Y

b.       under regional anaesthetic – N

c.       with IV sedation? – N 

In answering this query, our understanding of “day case procedure” is as a
formal admission to hospital as an elective theatre case in “Day Case
Theatre” i.e., with the anticipation that patient fulfils the criteria for
day case surgery and will have their admission and discharge within the
same day. This is opposed to Outpatient Hysteroscopy, where the procedure
is performed in outpatients on a non-admitted pathway.

All of our patients who require hysteroscopy for investigation will be
offered outpatient hysteroscopy with day case hysteroscopy under general
anaesthetic as an alternative. We do not routinely offer hysteroscopy as a
day case surgery under spinal or iv sedation.

 

3)      Do your hysteroscopy consent forms contain tick-boxes to enable a
patient to choose

a.       GA – Y

b.       regional anaesthesia – N  

c.       IV sedation – N

Our consent forms for patients having day case surgery (hysteroscopy) are
based on national consent forms and do have boxes for GA or regional
anaesthesia. We do not however currently routinely offer regional
anaesthesia for day case surgery hysteroscopy. If a patient preferred to
have hysteroscopy without general anaesthetic, this would be performed in
outpatients with local anaesthetic.

We do not currently offer IV sedation in either day case theatre or
outpatients.

 

4)      Have all your outpatient hysteroscopy teams received written
instruction to monitor the patient throughout the procedure, to ask if she
is experiencing pain, and to stop if the patient asks or is showing signs
of severe pain or distress

Yes

 

5)      Do all your hysteroscopy clinics routinely record ALL patients’
VAS pain-scores:

a.       as hysteroscope passes through the cervix – Y/N, 

b.       at biopsy – Y/N?

All patients are asked to give a verbal pain score of 0 – 10 (with 10
being the maximum/worst pain ever experienced). This is documented on our
hysteroscopy specific records.

 

6)      Does your hysteroscopy department send all its patients the RCOG’s
Patient Information Leaflet, published on its website

We have a local outpatient hysteroscopy leaflet that is sent out to all
patients.

 

7)      Does your hysteroscopy department intend to start using the RCOG
leaflet?

Our local leaflet which we have been using for over 2 years, has the same
detail of information as the RCOG leaflet. The next review date is Feb
2019 and has been reviewed alongside the RCOG leaflet and also in order to
produce a cross site document.

 

8)      If your hysteroscopy department uses its own Patient Information
Leaflet, please may I have a link to it? 

We do not currently have an electronic version of the patient information
leaflet

 

9)      Does the leaflet include ALL the key points listed (below) by the
RCOG

Yes – all points are covered by our leaflet which was created in January
2008 and last reviewed in Feb 2017. Next review is Feb 2019

 

Key points

·         Outpatient hysteroscopy (OPH) is a procedure carried out in the
outpatient clinic that involves examination of the inside of your uterus
(womb) with a thin telescope.

·         There are many reasons why you may be referred for OPH, such as
to investigate and/or treat abnormal bleeding, to remove a polyp seen on a
scan or to remove a coil with missing threads.

·         The actual procedure usually takes 10–15 minutes. It can take
longer if you are having any additional procedures.

·         You may feel pain or discomfort during OPH. It is recommended
that you take pain relief 1–2 hours before the appointment.

·         If it is too painful, it is important to let your healthcare
professional know, as the procedure can be stopped at any time.

·         You may choose to have the hysteroscopy under general
anaesthetic. This will be done in an operating theatre, usually as a
daycase procedure.

·         Possible risks with hysteroscopy include pain, feeling faint or
sick, bleeding, infection and rarely uterine perforation (damage to the
wall of the uterus). The risk of uterine perforation is lower during OPH
than during hysteroscopy under general anaesthesia.

 

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Amy Witham

Freedom of Information Team

East Suffolk and North Essex NHS Foundation Trust

Email: [2][East Suffolk and North Essex NHS Foundation Trust request email]

 

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