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

The request was successful.

Katharine Tylko-Hill

Dear Bedford 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."
________________________________________

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, Bedford Hospital NHS Trust

Thank you for contacting the Freedom of Information (FOI).

 

We will ensure that you receive a response as soon as possible.

 

Kind regards,

Bedford Hospital NHS Trust

FOI team

 

FOI, Bedford Hospital NHS Trust

Dear Katharine

I acknowledge receipt of your request under the Freedom of Information (FOI) Act, and you can expect the Trust’s response on or by 15/03/2019.
Yours sincerely,

IG/FOI Coordinator

Bedford Hospital NHS Trust
Kempston Rd | Bedford | MK42 9DJ

show quoted sections

FOI, Bedford Hospital NHS Trust

Dear Katharine,

 

I write in response to your request under the Freedom of Information (FOI)
Act. 

 

Please see the Trust’s replies below.

 

 

1.            Please tell me how many a) consultant obstetricians and b)
anaesthetists are onsite in your maternity department between the hours of
10pm to 8am, Monday to Sunday?

 

A) Consultants Obstetricians are only on site between 10pm and 8am if they
are requested to come in.

B)Consultant anaesthetists are not on site.

 

 

2.       Please tell me how many a) consultant obstetricians and b)
anaesthetists are on-duty but not onsite between the hours of 10pm to 8am,
Monday to Sunday?

 

A) there is one Consultant Obstetrician on-duty between these hours,
although if required they would call one of their colleagues to also
attend

B) One.

 

 

3.       Please tell me how many a) consultants obstetricians and b)
anaesthetists are onsite on Saturday or Sunday, between the hours of 8am
to 6pm?

 

A) One Consultant Obstetrician on site between these hours

B) One Consultant who is on site from 8 am to 12 noon, and he/she also
covers general emergency theatres

 

 

4.       Please state how many a) consultant obstetricians and b)
anaesthetists are onsite between the hours of 8am to 6pm, Monday to
Friday?

 

A) There is one Consultant Obstetrician specifically on-call and onsite
between these hours, but there are six more consultants in the department
at various times doing clinics, theatre work etc.

B)One dedicated to maternity. There are other consultant anaesthetists
working in the theatres.

 

 

5.       Please state the maximum distance on-duty consultant
obstetricians and anaesthetists can live away from the hospital? No more
than 30 minutes or 10 miles away

As above

 

 

This information is provided for your personal use and is the property of
Bedford Hospital NHS Trust and subject to any existing Intellectual
Property and Database Rights.  Any commercial application or use of this
information may be subject to the provisions of the Re-use of Public
Sector Information Regulations 2015 (RPSI).  This means that if you wish
to re-use the information provided for commercial purposes for any reason
you must ask the Trust for permission to do so.

 

I hope that this information is of help to you but if you are not
satisfied with the Trust’s response, or want to complain about the way in
which your request has been handled, you are entitled to request an
internal review.  To do so, please contact Data Protection Officer and
Information Governance Manager [1][email address]
and should your complaint not be upheld you have the right to appeal
against the decision by contacting the Information Commissioner’s Office,
Wycliffe House, Water Lane, Wilmslow SK9 5AF.

 

 

 

Yours sincerely

 

IG/FOI Coordinator

 

Bedford Hospital NHS Trust

Kempston Rd | Bedford | MK42 9DJ

 

 

 

 

show quoted sections

Katharine Tylko-Hill

Dear FOI,

Please would you send me the response to the request about hysteroscopy. I've received someone else's response.

Many thanks.

Yours sincerely,

Katharine Tylko-Hill

FOI, Bedford Hospital NHS Trust

Thank you for contacting the Freedom of Information (FOI).

 

We will ensure that you receive a response as soon as possible.

 

Kind regards,

Bedford Hospital NHS Trust

FOI team

 

Katharine Tylko-Hill

Dear Bedford Hospital NHS Trust,

Please may I have a request to the delayed request re Outpatient hysteroscopy.

Thank you.

Yours faithfully,

Katharine Tylko-Hill

FOI, Bedford Hospital NHS Trust

Dear Katharine,

I acknowledge receipt of your request under the Freedom of Information (FOI) Act, and you can expect the Trust’s response on or by 20/05/2019.

Yours sincerely,

IG/FOI Coordinator

Bedford Hospital NHS Trust
Kempston Rd | Bedford | MK42 9DJ

show quoted sections

Katharine Tylko-Hill

Dear FOI,

The response to my FOIA request re Outpatient hysteroscopy sent on 17 February 2019 is long overdue.

I was sent somebody else's answers!

Please may I have a response to my questions.

Thank you.

Yours sincerely,

Katharine Tylko-Hill

FOI, Bedford Hospital NHS Trust

Hi Katharine,

Apologies there has been a delay in our maternity department answering the questions. I can assure you it is being chased but our Consultants are very busy at the moment, hopefully we will have something back soon. Again, apologies it has breached the 20 days and for the previous mix up.

Regards,

FOI

show quoted sections

Katharine Tylko-Hill

Dear Bedford 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 Bedford 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...

Yours faithfully,

Katharine Tylko-Hill

Katharine Tylko-Hill

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

I'm still waiting for a reply to the questions I asked under FOIA in February.

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, Bedford Hospital NHS Trust

Thank you for contacting the Freedom of Information (FOI).

 

We will ensure that you receive a response as soon as possible.

 

Kind regards,

Bedford Hospital NHS Trust

FOI team

 

FOI, Bedford Hospital NHS Trust

1 Attachment

  • Attachment

    RE Freedom of Information request Outpatient hysteroscopy biopsy RCOG BSGE 2018 statement on Pain Control and Patient Choice.html

    17K Download

Hi Katharine,

I have looked into this and I can see that you are correct. We did provide a response in March (attached), but I can see that this was missing answers to questions 6-9. I do not know why this is but I will try to get a response from our maternity team as soon as possible. Please accept my apologies, I do remember we had some trouble with this one but I had thought we had responded in full. I know our Maternity dept had some difficulty answering the initial questions but hopefully we can get a response for 6-9.

Thank you,

FOI

show quoted sections

FOI, Bedford Hospital NHS Trust

Apologies Katharine, I can see there was a mix up with this and another
maternity FOI. We have answers for questions 1-2 of your original request
as below. We will return with answers to 3-9 shortly.

 

Thank you,

 

FOI

 

 

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?

[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."

________________________________________

 

The Trust does not record whether hysterscopists have read the statement
however the Trust adheres to RCOG guidelines.

 

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?

 

Hysteroscopy procedures are usually carried out as Day Cases and may be
offered the dependent on clinical need and discussions with the patient.

 

 

 

show quoted sections

FOI, Bedford Hospital NHS Trust

1 Attachment

Hi Katharine,

 

We are now able to respond to this request. I am very sorry for the mix up
and the subsequent delays. I hope the answers are satisfactory and again
please accept our apologies.

 

Many thanks,

 

FOI

 

 

 

Dear Ms Tylko-Hill,

 

I write in response to your request under the Freedom of Information (FOI)
Act. 

 

Please see the Trust’s replies below.

 

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

 

3.            Do your hysteroscopy consent forms contain tick-boxes to
enable a patient to choose a) GA? – No  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 

 

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?  No
[2]https://www.rcog.org.uk/en/patients/pati...

 

7.            Does your hysteroscopy department intend to start using the
RCOG leaflet – ? No 

 

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

 

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

 

 

 

 

 

This information is provided for your personal use and is the property of
Bedford Hospital NHS Trust and subject to any existing Intellectual
Property and Database Rights.  Any commercial application or use of this
information may be subject to the provisions of the Re-use of Public
Sector Information Regulations 2015 (RPSI).  This means that if you wish
to re-use the information provided for commercial purposes for any reason
you must ask the Trust for permission to do so.

 

I hope that this information is of help to you but if you are not
satisfied with the Trust’s response, or want to complain about the way in
which your request has been handled, you are entitled to request an
internal review.  To do so, please contact Data Protection Officer and
Information Governance Manager [3][email address]
and should your complaint not be upheld you have the right to appeal
against the decision by contacting the Information Commissioner’s Office,
Wycliffe House, Water Lane, Wilmslow SK9 5AF.

 

 

 

Yours sincerely

 

IG/FOI Coordinator

 

Bedford Hospital NHS Trust

Kempston Rd | Bedford | MK42 9DJ

 

 

 

From: FOI
Sent: 01 July 2019 10:57
To: 'Katharine Tylko-Hill' <[FOI #553132 email]>
Subject: FW: Internal review of Freedom of Information request -
Outpatient hysteroscopy/biopsy - RCOG/BSGE 2018 statement on Pain Control
and Patient Choice

 

Apologies Katharine, I can see there was a mix up with this and another
maternity FOI. We have answers for questions 1-2 of your original request
as below. We will return with answers to 3-9 shortly.

 

Thank you,

 

FOI

 

 

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?

[4]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."

________________________________________

 

The Trust does not record whether hysterscopists have read the statement
however the Trust adheres to RCOG guidelines.

 

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?

 

Hysteroscopy procedures are usually carried out as Day Cases and may be
offered the dependent on clinical need and discussions with the patient.

 

 

 

show quoted sections