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

The request was successful.

Katharine Tylko-Hill

Dear London North West University Healthcare 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 (LONDON NORTH WEST UNIVERSITY HEALTHCARE NHS TRUST), London North West University Healthcare NHS Trust

Dear Ms Tylko-Hill,

 

Thank you for your recent email to London North West University Healthcare
NHS Trust, which I can confirm is being treated as a FOI (Freedom of
Information) request.

 

Please note that our reference number for this request is 2016-19 (*please
quote this on all correspondence)

 

Should you have any further queries or information related to this
request, please do not hesitate in replying to this email.

 

Kind regards

 

FOI Team

London North West University Healthcare NHS Trust

[1][email address]

 

 

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Katharine Tylko-Hill

Dear London North West University Healthcare NHS Trust,

Please pass this on to the person who conducts Freedom of Information reviews.

I am writing to request an internal review of London North West University Healthcare NHS Trust's handling of my FOI request 'Outpatient hysteroscopy/biopsy - RCOG/BSGE 2018 statement on Pain Control and Patient Choice'.

My request is part of a nationwide survey to be presented at the British Society for Gynaecological Endoscopy in May. 100+ other Trusts have responded.

A full history of my FOI request and all correspondence is available on the Internet at this address: https://www.whatdotheyknow.com/request/o...

Yours faithfully,

Katharine Tylko-Hill

FOI (LONDON NORTH WEST UNIVERSITY HEALTHCARE NHS TRUST), London North West University Healthcare NHS Trust

1 Attachment

Dear Ms Tylko-Hill,

 

I am contacting you further to your email of 26 April 2019.

 

In order to help in addressing this matter, I would be grateful if you
could please advise of the FOI reference number that would have been sent
to you at the time of acknowledging your original request.

 

In relation to your advice that ‘A full history of my FOI request and all
correspondence is available on the Internet at this address:
[1]https://www.whatdotheyknow.com/request/o...
it is important to note that any documentation you may wish to provide is
included as part of your request.

 

Once in receipt of this information, we will of course investigate
further.

 

Kind regards

 

FOI Team

London North West University Healthcare NHS Trust

[2][email address]

 

 

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Katharine Tylko-Hill

Dear FOI (LONDON NORTH WEST UNIVERSITY HEALTHCARE NHS TRUST),

2016-19

Yours sincerely,

Katharine Tylko-Hill

FOI (LONDON NORTH WEST UNIVERSITY HEALTHCARE NHS TRUST), London North West University Healthcare NHS Trust

Dear Ms Tylko-Hill,

 

FOI Ref: 2016-19 (*Please quote this reference number on all
correspondence)

 

I am contacting you further to your most recent email of 26 April 2019,
and would like to start by offering my apologies for the delay in your FOI
request being formally responded to.

 

I can confirm that staff are currently in the process of gathering the
information requested as part of your email on 13 March 2019, and would
like to assure you that all of those staff involved have been asked to
ensure that this matter is addressed as soon as possible.  

 

I fully appreciate that this is not an ideal situation, however, as I hope
you will appreciate, before the Trust formally responds to any FOI
request, we have an obligation to ensure that all of the information being
provided is both accurate and up to date, and has been reviewed/verified
by all of those staff needed to provide information and/or comment.

 

I hope this information helps, and please be assured that we will of
course contact you again just as soon as this matter has been addressed,
which we hope to conclude shortly.

 

Kind regards

 

FOI Team

London North West University Healthcare NHS Trust

[1][email address]

 

 

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FOI (LONDON NORTH WEST UNIVERSITY HEALTHCARE NHS TRUST), London North West University Healthcare NHS Trust

1 Attachment

Dear Ms Tylko-Hill,

 

FOI Ref: 2016-19 (*Please quote this reference number on all
correspondence)

 

Please find below the response to your Freedom of Information request to
London North West University Healthcare NHS Trust.

 

I would like to take this opportunity to offer my apologies for the
unacceptable delay in this matter being formally responded to. 
Unfortunately, this delay appears to be owing to an administrative error,
and recent change in staffing, which has caused unnecessary delays in this
matter being formally responded to.  Please be assured that staff have
been reminded that such errors are unacceptable, and highlighted the
importance in ensuring that such issues do not reoccur.

 

You may re-use this information (except for logos) under the terms of the
Open Government Licence^1.  If you would prefer to receive the information
in an alternative electronic format, please let us know.

 

Please let us know if you require more details or further clarification. 
You can find out more about the Trust and our publication scheme at our
website^2.

 

I am now in a position to respond to your noted questions/query as
follows;

 

1.       a) Have your hysteroscopists read the following statement issued
by the RCOG in December 2018?

 

Yes

 

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

[1]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."

 

Yes

 

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                                       - No

b) under regional anaesthetic   - Yes

c) with IV sedation?                       - No

 

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

a) GA                                                    - Yes

b) regional anaesthesia               - Yes

c) IV sedation                                    - Yes

 

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     - No

b) at biopsy
                                                                       -
No

 

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/pati...

 

No

 

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

 

There are currently no plans to use the RCOG leaflet.

 

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

 

Please find attached (PDF 1.1)

 

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.

 

Yes

 

·         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.

 

Bleeding; Yes.  Polpys and missing coil threads are not mentioned

 

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

 

Local leaflet states approx. 25 minutes with potential to remain in dept.
for an hour

 

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

 

Yes

 

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

 

Not mentioned

 

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

 

No

 

·         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.

 

Infection risk outlined in addition to failure rate.

 

I hope this information helps, however, should you be dissatisfied with
our response, please use our FOI review process by contacting
[3][email address] or writing to:

 

Information Governance Manager (FOI Review)

Information Governance

Northwick Park Hospital

P Block

Watford Road

Harrow

HA1 3UJ

 

Please be aware that reviews will not be conducted via public forum, and
we will require your name and contact address in order to respond.

 

If you remain dissatisfied after a review, you have the right under s50 of
the Act to apply to the Information Commissioner’s Office for a decision.

 

Further details about this and the Act can be found on their website^3.

 

^1 Either version 3 or, at your discretion, any later version –
[4]http://www.nationalarchives.gov.uk/doc/o...

^2 [5]https://www.lnwh.nhs.uk/about-us/freedom...

^3 [6]http://www.ico.org.uk

 

FOI Team

London North West University Healthcare NHS Trust

[7][email address]

 

 

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