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

The request was successful.

Katharine Tylko-Hill

Dear North Bristol 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

Freedom of Information, North Bristol NHS Trust

Dear Katharine,

Thank you for your request for information under the terms in the Freedom of Information Act 2000. Your request has been forwarded to the appropriate department for consideration and will be responded to within 20 working days.

Reference number: 5404-03-19

Kind Regards
Sandra

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Sandra

Sandra Carter
Workforce Information Assistant, Business Intelligence Team, IM&T
Tues, Wed, Thurs 7am – 1pm
Annual Leave Notice: 12th, 13th & 14th March 19
Christopher Hancock Building, Southmead Hospital
North Bristol NHS Trust, Bristol, BS10 5NB
T: 0117 4142364
E: [email address]

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Katharine Tylko-Hill

Dear North Bristol NHS Trust,

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

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

My request was made in March.

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

Thank you for your help.

Yours faithfully,

Katharine Tylko-Hill

Katharine Tylko-Hill

Dear North Bristol NHS Trust,

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

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

My request was made in March.

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

Freedom of Information, North Bristol NHS Trust

Dear Ms Tylko-Hill

Thank you for your email of 22nd August. Apologies for the delay in responding, we have had some issues obtaining the information you have requested. I anticipate getting the information to you at the end of next week. If there are any further delays or issues I will of course let you know as soon as possible.

Kind Regards

Helen

Helen Williamson
Head of Information Governance, Business Intelligence Team, IM&T
Work Pattern: Mon, Tue, Thur, Fri 7:30am – 5:00pm
Annual Leave Notice:
Christopher Hancock Building, Southmead Hospital
North Bristol NHS Trust, Bristol, BS10 5NB
T: 0117 41 44767
E: [email address]

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Freedom of Information, North Bristol NHS Trust

Dear Ms Tylko-Hill

Thank you for your request for information of 13th March 2019, apologies for the lengthy delay. In compliance with the Freedom of Information Act 2000, our response is below.

1. a) Have your hysteroscopists read the following statement issued by the RCOG in December 2018 - Y/N?
– Cannot confirm

b) Have your hysteroscopy managers read the following statement – Y/N?
– Cannot confirm

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? – Yes
b) under regional anaesthetic – Y/N? – No
c) with IV sedation? - No

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?
– No we offer OP procedure or GA procedures and the consent is taken once the method of procedure is decided.

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?
– This is routine practice and our multiprofessional team are all there to support the patient. We have an allocated nurse or HCA who will be monitoring the patient and checking they are OK or alerting the hysteroscopist if they are concerned.

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?
– No we have audited our patient experience in the past and will do so again in the future but do not record for all cases

6. Does your hysteroscopy department send all its patients the RCOG’s Patient Information Leaflet, published on its website - Y/N?
– We have our own leaflet that all women should be given and is on our website. 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?
– We are happy with our leaflet at present but are looking at how we can ensure patient information is available to our women and will review as part of this.

8. If your hysteroscopy department uses its own Patient Information Leaflet, please may I have a link to it?
– It on the NBT website: https://www.nbt.nhs.uk/our-services/a-z-...

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. -yes
• The actual procedure usually takes 10–15 minutes. It can take longer if you are having any additional procedures. - Yes
• 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. - No
• You may choose to have the hysteroscopy under general anaesthetic. This will be done in an operating theatre, usually as a daycase procedure. - yes
• 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 – Yes but does not specify that risk of OPH may be less

Your request has been fully discharged, but I should be pleased to offer any further assistance that you may require.

We should advise that you have the right to complain about this response by reference to the complaints procedure of the North Bristol NHS Trust, in which case you should write to:

Advice & Complaints Team (ACT)
Beaufort House,
Beaufort Way,
Southmead Hospital,
Southmead,
Bristol BS10 5NB

Email: [email address]

If you remain dissatisfied with the decision of North Bristol NHS Trust following your complaint, you may write to the Information Commissioner, whose address is:

Information Commissioner's Office
Wycliffe House
Water Lane
Wilmslow
Cheshire SK9 5AF

The Trust asks that you note, that the information you have been supplied may be subject to the Copyright, Designs & Patents Act 1988. You may re-use the information provided for personal use, (not including logos), free of charge in any format or medium. However, you must re-use it accurately and not in a misleading context. You must acknowledge the information as North Bristol NHS Trust copyright and give the title of the document/publication. Where we have identified any third party copyright material you will need to obtain permission from the copyright holders concerned.

Kind Regards

Helen

Helen Williamson
Head of Information Governance, Business Intelligence Team, IM&T
Work Pattern: Mon, Tue, Thur, Fri 7:30am – 5:00pm
Annual Leave Notice:
Christopher Hancock Building, Southmead Hospital
North Bristol NHS Trust, Bristol, BS10 5NB
T: 0117 41 44767
E: [email address]

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