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

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Katharine Tylko-Hill

Dear Leeds Teaching Hospitals 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."
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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

informationgovernance (LEEDS TEACHING HOSPITALS NHS TRUST), Leeds Teaching Hospitals NHS Trust

Dear Ms Tyklo-Hill

We acknowledge receipt of your e-mail requesting information from the Trust under the provisions of the Freedom of Information Act 2000 ("the Act"). Please note that whilst the Trust strives to be open and is normally able to satisfy requests in full, the right of access is not absolute and we may therefore have to refuse queries, either in full or in part, on the basis of the exemptions (for example, in cases where disclosure would breach patient confidentiality, or put people in danger). All such decisions will be made, and fully justified, in accordance with the law.

We are required under the Act to respond to valid queries no later than the twentieth working day following receipt. Your request was received on 13/03/2019, which means our deadline for response calculates to 10/04/2019. If we are able to respond to you sooner than this, we will do so.

Should you have any queries or concerns in the meantime, please contact us directly using the e-mail address below - quoting reference number 19-1182

Please note: if, having fully considered your request, we reasonably require further information in order to respond, we will request this from you by e-mail as soon as possible. In all such cases, the above timescales will be disregarded and the 20 working day clock shall instead begin once we have received the necessary clarification. There shall be no duty for us to comply with your request until we receive this information from you.

Kind Regards

Lorna

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informationgovernance (LEEDS TEACHING HOSPITALS NHS TRUST), Leeds Teaching Hospitals NHS Trust

1 Attachment

Dear Sir/Madam  
 
Please find attached herewith a response to your Freedom of Information
query.
 
Kind regards

Lorna

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