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

The request was successful.

Katharine Tylko-Hill

Dear North Middlesex University Hospital 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

Katharine Tylko-Hill

Dear North Middlesex University Hospital 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 Middlesex University Hospital NHS Trust's handling of my FOI request 'Outpatient hysteroscopy/biopsy - RCOG/BSGE 2018 statement on Pain Control and Patient Choice'.

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

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.

Yours faithfully,

Katharine Tylko-Hill

freedomofinformation (NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST), North Middlesex University Hospital NHS Trust

Dear Katharine Tylko-Hill

Thank you for your email.

I am sorry I have no record of the previous communication. I cannot confirm whether the Trust holds this data however I am endeavouring to process your request urgently and will get back to you as soon as I have information.

Anne Appadoo
Head of Information Governance & Data Protection Officer
North Middlesex University Hospital NHS Trust

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Katharine Tylko-Hill

Dear freedomofinformation (NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST),

Thank you very much for chasing up the request re Outpatient Hysteroscopy delivered on 13th March by www.whatdotheyknow.com.

Yours sincerely,

Katharine Tylko-Hill

freedomofinformation (NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST), North Middlesex University Hospital NHS Trust

2 Attachments

Dear Ms Tylko Hill

Thank you for your request for information under the Freedom of Information Act 2000. Please see the attached a completed questionnaire in response to the queries you raised.

I also attach the current patient information leaflet. Please not that this leaflet is currently under review and is imminently due to be updated.

If you require any further information, please contact me via this email address.

I should advise that if you are not satisfied with the above response you may, under the Trust's complaints procedure, write to the Chief Executive requesting an internal review. The address to write to is:

The Chief Executive,
Trust Head Quarters
Admin Block
Sterling Way,
N18 1QX

Email [email address]

requesting an internal review.

If you remain dissatisfied with the Trust’s decision following your complaint, you may write to the Information Commissioner for a decision under Section 50 of the Freedom of Information Act. The Information Commissioner can be contacted at:

Information Commissioner's Office
Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF.
Telephone: 01625 545700
www.informationcommissioner.gov.uk

Yours sincerely

Anne Appadoo
Head of Information Governance & Data Protection Officer
North Middlesex University Hospital NHS Trust

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