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

The request was successful.

Katharine Tylko-Hill

Dear University Hospitals of Leicester NHS 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 - Freedom of Information, University Hospitals of Leicester NHS Trust

1 Attachment

Our Reference: LS/FOI/40551

 

18 February 2019

 

Katharine Tylko-Hill

[1][FOI #553237 email]

 

Dear Ms Tylko-Hill,

 

Request for Information

 

Thank you for your request for information, as received via email by
University Hospitals of Leicester NHS Trust on 18 February 2019.  Within
UHL NHS Trust, Freedom of Information Act requests are managed centrally
by the Corporate and Committee Services Team, and I confirm that your
request is now being handled under the Freedom of Information Act 2000.

 

The Trust will endeavour to provide a response within the required 20
working-day deadline.  I will, of course, keep you informed should this
not prove possible for any reason. If we require any clarification on your
request, we will contact you as soon as possible.

 

All requesters are advised that the Trust may make a charge for providing
the information to them, to cover the cost of photocopying, postage and
packaging etc – I confirm that where these costs are below £5.00 in total,
no charge will be made.  All requesters are also advised that there may
also be a charge payable to cover costs of locating the information they
have requested, as laid down in the Freedom of Information Act Regulations
published by the Government in December 2004.  Naturally, if such a charge
is to be applied to your request, you will be informed as soon as
possible.

 

Yours sincerely,

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Luke Saunders

Litigation/Corporate and Committee Services

* Belgrave House, Leicester General Hospital, LE5 4PW

(  0116 258 8932/8610

8   [3][email address]

 

Information contained in emails may be subject to disclosure under the
Freedom of Information Act 2000, and confidentiality cannot therefore be
guaranteed.  Please ensure that all emails are accurate and appropriate,
and are retained/deleted in accordance with good practice and any policies
of the Trust.  If you are not the intended recipient of this email, please
inform the sender, delete the email from your system and destroy any
copies you may have made.

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FOI - Freedom of Information, University Hospitals of Leicester NHS Trust

2 Attachments

Our Reference: LS/FOI/40551

 

18 March 2019

 

Katharine Tylko-Hill

[1][FOI #553237 email]

 

Dear Ms Tylko-Hill,

 

Request for Information

 

Thank you for your Freedom of Information Act (FOI) request, as received
on 18 February 2019 and acknowledged on that date. For information, the
University Hospitals of Leicester NHS Trust is one of the largest and
busiest NHS teaching Trusts in the country incorporating the Leicester
Royal Infirmary, Glenfield and Leicester General Hospitals. Our three
hospitals have around 15,000 staff serving around 1.2 million people
across Leicester, Leicestershire and Rutland, and a further two to three
million people from the rest of the UK who come to us for treatment from
one of our specialist services.  During 2017/18 we treated 1,410,500
patients - that’s 3,864 patients each day.

 

Following consultation with colleagues from the Women’s and Children’s
Clinical Management Group, I confirm that the University Hospitals of
Leicester NHS Trust holds information covered by your FOI request.   In
your Freedom of Information Act request, you asked for the following
information and the Trust’s response is provided below following each
section of your request:-  

 

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

 

b) Have your hysteroscopy managers read the following statement – Y/N? –
Yes

 

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? – Yes

b) under regional anaesthetic – Y/N? – No – available for prolonged
hospital stay

c) with IV sedation? – Not available in our trust, not required to offer
this as there is no good evidence for it’s use.

 

2.       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?

 

Yes – we don’t have tick boxes but the option is there

 

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? Yes, this is standard operating
procedure and good medical practice

 

5. Do all your hysteroscopy clinics routinely record ALL patients’ VAS
pain-scores – This is being introduced as a trial.

 

a) as hysteroscope passes through the cervix – Y/N, As above

b) at biopsy – Y/N? As above

 

6. Does your hysteroscopy department send all its patients the RCOG’s
Patient Information Leaflet, published on its website - Y/N?
[2]https://www.rcog.org.uk/en/patients/patii... No, we have a locally
agreed leaflet which reflects the same advice as the RCOG leaflet but also
contains contact information for the trust.

 

7. Does your hysteroscopy department intend to start using the RCOG
leaflet – Y/N? If so, in which month/year? No – our leaflet has local
contact details in.

 

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

 

9. Does the leaflet include ALL the key points listed (below) by the RCOG
– Y/N? Yes and more.

 

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.

 

I hope that this response is helpful and provides you with the information
requested (where available). If you require any further assistance please
do not hesitate to contact me.  If you are dissatisfied with the Trust’s
response, you can contact the Director of Corporate and Legal Affairs on
Tel. No. 0116 258 8615 to request a copy of UHL’s Freedom of Information
Act complaints procedure.

 

We must advise you that where we have provided information we have done so
subject to the provisions of the Re-use of Public Sector Information
Regulations 2005.  Accordingly you must not re-use this information
without having the consent of the Trust.  Where the Trust is prepared to
provide its consent then it may levy a charge for doing so. Should you
wish to re-use documents provided then you must make your request in
writing stating your name and your address for correspondence together
with the document that you wish to re-use and the purpose for which the
information is to be re-used.

 

In the event that you remain dissatisfied with the way in which the Trust
has handled any complaint that you may wish to make, we would advise you
of your right to complain to the Information Commissioner at the
Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow,
Cheshire, SK9 5AF.

 

Yours sincerely,

[3]Description: Description: Description: Description: Description:
Description: Description: Description: Description: Description:
Description: Description: Description: Description: Description:
Description: Description: Description: Description: Description:
Description: Description: Description: Description: Description:
Description: Description: Description: hello-my-name-is-logo-web-small

Luke Saunders

Litigation/Corporate and Committee Services

* Belgrave House, Leicester General Hospital, LE5 4PW

(  0116 258 8610

8   [4][email address]

 

Information contained in emails may be subject to disclosure under the
Freedom of Information Act 2000, and confidentiality cannot therefore be
guaranteed.  Please ensure that all emails are accurate and appropriate,
and are retained/deleted in accordance with good practice and any policies
of the Trust.  If you are not the intended recipient of this email, please
inform the sender, delete the email from your system and destroy any
copies you may have made

 

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Katharine Tylko-Hill

Dear FOI - Freedom of Information,

Please would you send me a link to your locally agreed patient leaflet on outpatient hysteroscopy that was missing from the request. You only sent the Day Case hysteroscopy leaflet.

Many thanks

Yours sincerely,

Katharine Tylko-Hill

FOI - Freedom of Information, University Hospitals of Leicester NHS Trust

2 Attachments

Dear Ms Tylko-Hill,

 

Thank you for your email below - please see attached the Trust's
information leaflet on "having a hysteroscopy and biopsy as an
outpatient".  The leaflet can be accessed electronically at:  
[1]https://yourhealth.leicestershospitals.n...

Yours sincerely,

 

[2]Description: Description: Description: Description: Description:
Description: Description: hello_my_name_is_logo_coloured

Helen Stokes

Corporate and Committee Services Manager

Belgrave House, Leicester General Hospital site

University Hospitals of Leicester NHS Trust

Tel: 0116 258 8590

 

Information contained in emails may be subject to disclosure under the
Freedom of Information Act 2000, and confidentiality cannot therefore be
guaranteed.  Please ensure that all emails are accurate and appropriate,
and are retained/deleted in accordance with good practice and any policies
of the Trust.  If you are not the intended recipient of this email, please
inform the sender, delete the email from your system and destroy any
copies you may have made.

 

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