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

Katharine Tylko-Hill made this Freedom of Information request to Royal Free London NHS Foundation Trust

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Katharine Tylko-Hill

Dear Royal Free London NHS Foundation 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, Rf (ROYAL FREE LONDON NHS FOUNDATION TRUST), Royal Free London NHS Foundation Trust

Dear Ms Tylko-Hill

Thank you for your request under the Freedom of Information Act. The reference for this request is noted in the subject header above.

You will receive a response from us within 20 working days of receipt or an explanation as to why this is not possible. If your request is outside the scope of the Freedom of Information Act 2000 we will advise you accordingly.

Yours sincerely

Freedom of Information Team
Royal Free London NHS Foundation Trust

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FOI, Rf (ROYAL FREE LONDON NHS FOUNDATION TRUST), Royal Free London NHS Foundation Trust

1 Attachment

 

Dear Ms Tylko-Hill

 

Thank you for submitting a request for information under the Freedom of
Information Act 2000.  Please find the response below in red font. This
response covers the hospitals and services managed by the Royal Free
London NHS Foundation Trust, namely the Royal Free Hospital, Barnet
Hospital and Chase Farm Hospital and associated group services.  

 

 

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 – Yes

 

b) Have your hysteroscopy managers read the following statement – Yes

[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."

________________________________________

 

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 – Yes b) under regional anaesthetic – No  c) with IV sedation? No

Royal Free Hospital

We offer general anaesthetic or outpatient hysteroscopy from the outset;
patients see a nurse following referral where the options are discussed.

 

Barnet Hospital

Patients that are referred on a cancer pathway are directly triaged to Out
Patient Hysteroscopy at that appointment if the procedure cannot be
tolerated they are given the option for a general anaesthetic which we aim
to book within 2 weeks.

 

Patients attending for outpatient procedures are advised to take oral
analgesia prior to arrival.

 

Logistically regional anaesthetic and sedation not routinely done in our
units unless in high risk medically unfit cases. We don’t routinely offer
sedation as women may still experience discomfort hence general
anaesthetic preferred in this group of patients.

 

  

3. Do your hysteroscopy consent forms contain tick-boxes to enable a
patient to choose a) GA – Yes b) regional anaesthesia – No  c) IV sedation
– No

 

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 (Royal Free Hospital)  At Barnet Hospital
this is not written but this is standard practice and all staff actively
do this. 

 

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? Only during research settings do we record VAS scores. It is
not required outside of research setting. If a patient is in pain, or we
as a team feel they are uncomfortable the procedure is abandoned.

 

6. Does your hysteroscopy department send all its patients the RCOG’s
Patient Information Leaflet, published on its website - No?
[2]https://www.rcog.org.uk/en/patients/pati... We have our own leaflet as
the RCOG updates were not available when we last updated our leaflet.

 

7. Does your hysteroscopy department intend to start using the RCOG
leaflet –We will consider this.

 

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

 

9. Does the leaflet include ALL the key points listed (below) by the RCOG

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. We do not  mention remove
coils with missing threads.

• 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.  Not
specifically mentioned in the leaflet

• You may choose to have the hysteroscopy under general anaesthetic. This
will be done in an operating theatre, usually as a daycase procedure.
This is not in the leaflet but discussed face to face.

• 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. All except perforation is
on the leaflet but this is mentioned on signing the consent form.

 

 

Your appeal rights

 

I hope that this response deals with your enquiry to your satisfaction,
however if not you have two courses of action:

 

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information request and explain what you would like us to review. 
Appeals should be made in writing, within 40 working days of the date
of the response, and addressed to Ms Emma Kearney, chief
communications officer, Royal Free London NHS Foundation Trust at
[3][email address]

 

If you are not satisfied with the internal review, you can appeal to the
Information Commissioner.  The contact details are: Information
Commissioner's Office, Wycliffe House, Water Lane, Wilmslow, Cheshire, SK9
5AF, telephone 01625 545 700 or see [4]www.ico.org.uk

 

Open Government License

The trust allows you to reuse this information under the Open Government
License found at the following [5]link. 

 

Yours sincerely

 

 

 

Alison Macdonald

Board Secretary

 

 

 

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