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

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Katharine Tylko-Hill

Dear Sandwell and West Birmingham 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."
________________________________________

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

SWBH-GM-FOIRequests (SANDWELL AND WEST BIRMINGHAM HOSPITALS NHS TRUST), Sandwell and West Birmingham Hospitals NHS Trust

Thank you for your freedom of information request received on 17TH MARCH 2019 (below).

Your request will now be considered in accordance with the Freedom of Information Act 2000. You will receive a response within the statutory timescale of 20 working days after the date of receipt as defined by the Act, subject to the information not being exempt or containing a reference to a third party. In some circumstances we may be unable to achieve this deadline. If this is likely you will be informed and given a revised timescale at the earliest opportunity.

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Kind regards.

Freedom of Information
[Sandwell and West Birmingham Hospitals NHS Trust request email]
 Trust Headquarters, Health and Wellbeing Centre, Sandwell General Hospital, Lyndon, West Bromwich B71 4HJ

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Katharine Tylko-Hill

Dear SWBH-GM-FOIRequests (SANDWELL AND WEST BIRMINGHAM HOSPITALS NHS TRUST),

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

Thank you.

Yours sincerely,

Katharine Tylko-Hill

SWBH-GM-FOIRequests (SANDWELL AND WEST BIRMINGHAM HOSPITALS NHS TRUST), Sandwell and West Birmingham Hospitals NHS Trust

Dear Katharine,

Thank you for your email.

Please accept my apologies for the delay in responding to your request. I have followed this up for you and as soon as I have the information you have requested I will send this to you.

Please note your reference number for this request is F18/0027.

If you have any further queries, please feel free to contact me.

Kind Regards

Aisha Begum
Freedom of Information
FF[Sandwell and West Birmingham Hospitals NHS Trust request email]
s Trust Headquarters, Health and Wellbeing Centre, Sandwell General Hospital, Lyndon, West Bromwich B71 4HJ

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SWBH-GM-FOIRequests (SANDWELL AND WEST BIRMINGHAM HOSPITALS NHS TRUST), Sandwell and West Birmingham Hospitals NHS Trust

FOI request ref: F18/0027

Dear Katharine,

Thank you for your freedom of information request received on 17 March 2019 by Sandwell and West Birmingham Hospitals NHS Trust.

Following receipt of your request, searches were conducted to locate information relevant to your request and I can confirm that the information you have requested is held by Sandwell and West Birmingham Hospitals NHS Trust and is detailed below:

1.a) Have your hysteroscopists read the following statement issued by the RCOG in December 2018 - Y/N? Yes

b) Have your hysteroscopy managers read the following statement – Y/N? Yes
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?
Yes

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?
Yes

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? Yes

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, pain is measured on a whole prior to procedure, during and after procedure.

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...
No, patients receive a bespoke hospital approved information booklet created and produced by Sandwell and West Birmingham hospital NHS trust.

7.Does your hysteroscopy department intend to start using the RCOG leaflet – Y/N? If so, in which month/year?
No.

8.If your hysteroscopy department uses its own Patient Information Leaflet, please may I have a link to it?
Yes the Trust uses its own Patient Information Leaflet, a hard copy is available upon request.

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.

Yes

I hope that the information provided in this email answers your query. However, if you are dissatisfied with the response please contact the Trust in the first instance with the details of your complaint so the Trust can conduct an internal review. Please address such requests to [Sandwell and West Birmingham Hospitals NHS Trust request email] or in writing to Kam Dhami, Director of Governance, Trust Headquarters, Sandwell Hospital, Lyndon, West Bromwich, B71 4HJ. Alternatively, if you remain unhappy with the outcome you can appeal directly to the Information Commissioner at the following address: www.ico.gov.uk

Kind Regards

Aisha Begum
Freedom of Information
[Sandwell and West Birmingham Hospitals NHS Trust request email]
Trust Headquarters, Health and Wellbeing Centre, Sandwell General Hospital, Lyndon, West Bromwich B71 4HJ

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