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

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Katharine Tylko-Hill

Dear Mid Yorkshire 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

FOI, Mid Yorkshire Hospitals NHS Trust

ACKNOWLEDGEMENT OF FOI REQUEST

Thank you for your request for information received on 13th March 2019. It has been allocated the reference number FOI 18/19 4419 and is being dealt with under the terms of the Freedom of Information Act 2000.

Our aim is to provide the information as quickly as possible within 20 working days of receiving your request. Should there be any difficulty or delay you will be informed of the reasons and expected outcome. In some circumstances a fee may be payable, if this is the case, you will be informed and a fees notice will be issued to you. Payment is then required before we proceed with your request.

If you require further information as to the process or have any queries in relation to your request, please contact me quoting the reference above.

Kind Regards
Response Issued by
FOI Lead on behalf of The Mid Yorkshire Hospitals NHS Trust
Pinderfields Hospital,
Aberford Road
Wakefield
WF1 4DG

Tel: 0844 811 8110
Email: [email address]

Section 10(1) of the Act states that:
“Subject to subsections (2) and (3), a public authority must comply with section 1(1) promptly and in any event not later than the twentieth working day following the date of receipt.”

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FOI, Mid Yorkshire Hospitals NHS Trust

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Re : Freedom of Information Act request - 4419
Thank you for your freedom of information request. Please find attached our response.
If you are not satisfied with the way in which your FOI request has been handled or with the response you have received, please contact the Company Secretary at Mid Yorkshire Hospitals NHS Trust via [email address] requesting an investigation.

The Information Commissioner’s Office will investigate matters relating to FOI requests but will usually refer the matter back to the Trust in the first instance to explore opportunities for local resolution.

The information Commissioner can be contacted at:

Information Commissioner’s Office
Wycliffe House
Water Lane
Wilmslow
Cheshire SK9 5AF
Fax: 01625 524 510

Response Issued by
FOI Lead on behalf of The Mid Yorkshire Hospitals NHS Trust
Pinderfields Hospital,
Aberford Road
Wakefield
WF1 4DG

Tel: 0844 811 8110
Email: [email address]

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