Ref: FOI/GS/ID 1895
Please reply to:
FOI Administrator
Trust Management
Service Centre
Maidstone Hospital
Hermitage Lane
Maidstone
Kent
ME16 9QQ
Email:
12 February 2014
Katherine Tylko-Hill
Dear Ms Tylko-Hill
Freedom of Information Act 2000
I am writing in response to your request for information made under the Freedom of Information Act 2000 in relation to Outpatient Hysteroscopy/Biopsy – Pain Control and Patient Choice.
Please see the Trust response below:
1. The current patient information leaflet- attached
2. The current consent form- part of hysteroscopy patient information leaflet
3. The current surgical protocol- attached
4. Does the leaflet advise the patient to ask her GP to prescribe gynae-specific painkillers to be taken BEFORE the procedure - The Trust does not advise patients to take painkillers before the procedure.
5. What type and dose of painkillers does your Trust advise patients to take before the procedure? - The Trust does not advise patients to take painkillers before the procedure.
6. Are ALL your hysteroscopy/biopsy patients given the following choices BEFORE the procedure is attempted:
a) General Anaesthesia – No
b) spinal anaesthesia – No
c) conscious sedation – No
Outpatient diagnostic procedures are advocated unless during the discussion the patient has clinical indications that General anaesthesia is required.
7. For each of the last 3 financial years, how many of your hysteroscopy/biopsy patients had
a) GA with overnight stay?
b) GA day-case ?
c) spinal anaesthesia?
d) conscious sedation?
e) local anaesthetic?
f) no anaesthetic?
Please see the attached tables.
8. What width hysteroscopes do you use? Rigid or flexible? –
Diagnostic 2.7mm/rigid scopes
9. For each of the last 3 financial years what % patients DNA outpatient hysteroscopy/biopsy?- see table attached
10. For each of the last 3 financial years what % OP hysteroscopy/biopsy patients had a failed procedure that had to be repeated with epidural, GA or conscious sedation?
The Trust has estimated that it will cost more than the appropriate limit to consider this part of your request. The appropriate limit is specified in regulations and represents the estimated cost of one person spending 3½ working days in determining whether the Trust holds the information, locating, retrieving and extracting the information. Under Section 12 of the Freedom of Information Act 2000 the Trust is not obliged to comply with your request and we will not be processing your request further.
11. All audits of adverse events, e.g. infection, perforation during the last 3 financial years-
There have been no adverse events during the last 3 financial years relating specifically to hysteroscopies.
12. All surveys of patients’ experiences during the last 3 financial years-
13/14 Programme
Audit of Out Patient Services for Hysterscopy,
Targets Partially Met (Didn’t meet: waiting times, satisfaction in arranging appointments)
10/11 Programme
Patient Satisfaction Survey Obstetrics & Gynaecology Out Patients – Overall Good Level of Satisfaction
If you have any queries about this letter please do not hesitate to contact me. Please remember to quote the reference number above in any future communications.
If you are unhappy with the service you have received in relation to your request and wish to make a complaint or request a review of our decision, you should write in the first instance to:
Mr Glenn Douglas
Chief Executive
Maidstone & Tunbridge Wells NHS Trust
Maidstone Hospital
Hermitage Lane
Maidstone
Kent ME16 9QQ
If you are not content with the outcome of your complaint you may apply directly to the Information Commissioner for a decision. Generally the Information Commission cannot make a decision unless you have exhausted the complaints procedure provided by the Chief Executive’s Office. The Information Commissioner can be contacted at:
The Information Commissioner’s Office
Wycliffe House
Water Lane
Wilmslow
Cheshire
SK9 5AF
Yours sincerely
Gail Spinks
Head of Information Governance
Enc: patient information leaflet
current surgical protocol
Inpatient and outpatient data for the last 3 financial years
HYSTEROSCOPY
Information for patients
What is a hysteroscopy?
Hysteroscopy is a very simple procedure to look inside the womb. This can be done as an outpatient with or without a local anaesthetic or as an inpatient under a general anaesthetic. Outpatient hysteroscopy is suitable for most women but you and your doctor will decide which is most appropriate for you.
I have read and understood the contents of this leaflet
Signed …………………………………………
Date …………………………………………
PLEASE BRING THIS LEAFLET WITH YOU TO CLINIC
( Telephone
The Tunbridge Wells Hospital
01892 633669
The Maidstone Hospital
01622 224797
What are the risks of the procedure/treatment?
As with any procedure, there are associated risks. Hysteroscopy is safe and complications are rare. Those which have been noted include:
· Minor injury to the cervix or uterus
· Infection
· Bleeding
· Adverse reaction to the anaesthetic
· Perforation of the uterus is a possibility and rarely can damage occur to the bladder or bowel
Why do I need a hysteroscopy?
Hysteroscopy is necessary for a variety of reasons which include:
· Abnormal bleeding
· Bleeding between your periods
· Bleeding after the menopause
· Heavy bleeding
· Irregular bleeding on HRT
· Locating or inserting coils
· Occasionally for infertility or recurrent miscarriage
What will happen to me?
As an outpatient it is sensible to bring someone with you, so that you don’t have to drive yourself home. It is wise to then take things easy for the rest of the day.
· If you are very nervous, see your GP or contact the hysteroscopy nurse or co-ordinator beforehand
· Please let us know if you have a heart murmur or have had heart surgery in the past
· Before the procedure a trained nurse and the hysteroscopist will talk to you and answer any questions you may have
· You will be asked to sign the front page of this leaflet to say you understand the procedure and any risks
· You will be asked to remove your clothes below the waist and wear a hospital gown
· A trained nurse will be with you throughout the whole procedure
During the procedure
· A speculum may be inserted into the vagina (as for a smear)
· The hysteroscope (a thin telescope about the diameter of a drinking straw) is then inserted through the cervix (neck of the womb) into the womb itself
· In order to get a good view of a small amount of water, occasionally gas is passed through the scope to gently form a cavity. This ensures that the hysteroscopist is able to see the whole of the lining of the womb
· A biopsy (a small piece of tissue) from the lining of the womb may be taken. Occasionally small polyps may be removed
After the procedure, the hysteroscopist will discuss with you your future management
Does it hurt and how will I feel after the procedure?
Most of our patients leave saying it wasn’t as nearly as bad as they expected.
During the procedure, you may have some period type pain and very rarely shoulder pain. Paracetamol will be offered should you need it. There may be a small amount of vaginal bleeding for the following two to three days
Bleeding should never be heavy or contain large clots
How long will I be in hospital?
You will be in the department for approximately one hour, but the procedure itself only takes ten to twenty minutes. Once you are dressed you will be offered tea or coffee whilst the hysteroscopist talks to you about the examination and allowing you time to ask any questions
Advantages of outpatient hysteroscopy
· No unwanted side effects of general anaesthetic
· Ability to consult with the hysteroscopist during and after the procedure
· You will be able to go home almost immediately after the hysteroscopy
Inpatient hysteroscopy
If you and your doctor decide this is best for you, then you will be sent an admission form for day surgery. The procedure is the same but you will be asleep while it is being carried out. You should be able to go home later that day providing you are well enough after the anaesthetic.
Any more questions?
This information leaflet will answer some of your questions but if there is anything else at all you would like to know, please make a note of it and ask the nurse or the doctor before or at the time of your appointment.
MTW NHS Trust is committed to making its patient information accessible in a range of languages and formats. If you need this leaflet in another language or format please ask one of your clinical care team or the PALS Team. We will do our best to arrange this.
Patient Advice and Liaison Service (PALS)
If you would like to raise any concerns, make comments and suggestions or require information on Trust services, you can contact PALS. Office opening times are Monday to Friday 10.00am to 4.00pm. Both offices offer a 24 hour answering machine. Messages will be responded to within one working day, so please do leave a contact number.
PALS Maidstone Hospital ( 01622 224960
PALS Tunbridge Wells ( 01892 632953
PALS Email
PALS SMS ( 07747 782317
PALS Maidstone Fax ( 01622 224843
PALS Tunbridge Wells Fax ( 01892 632954
We welcome patient feedback. Please send comments to: [add author email address]
OR
We welcome patient feedback. Please discuss any issues with your clinician.
Issue date: Pending Approval Review date: TBA
Database reference: GOV/LEA/4 © MTW NHS Trust
Criteria for Hysteroscopy under General Anaesthetic
It is accepted practice at MTW that we will routinely offer hysteroscopy’s as an outpatient procedure. However about 10% of patients require an inpatient GA hysteroscopy for a variety of reasons, including:-
· Unable to tolerate speculum exam
Inability to tolerate cervical dilatation
· Cervix is not visible / accessible with speculum
· Those uncomfortable with concept of outpatient hysteroscopy after counselling
· Stenosis of the Cervical Os
· Vaginismus
Medical reasons why Outpatient hysteroscopy is pointless:-
Large endometrial / submucous lesions (polyps >2cm, fibroids >2cm).
Coexisting pelvic pathology (large Ovarian cysts etc).
Hyperplasia suggested on USS, bleeding while taking Tamoxifen. In these cases
pathology can be diffuse so hysteroscopy with curettage may be best way to acquire a
representative sample.
Thin endometrium, <3mm (see PMB criteria) seen on USS.
Q7)Number of patients in the last 3 financial years that had the following:
11/12 / 12/13 / 13/14
a) GA with overnight stay? / 27 / 22 / 13
b) GA day-case ? / 199 / 224 / 178
c) spinal anaesthesia? / 3 / 2 / 1
d) conscious sedation? / 5 / 9 / 8
e) local anaesthetic? / 7 / 4 / 5
f) no anaesthetic?
Cannulated on Ward / 2 / 13 / 4
Unknown/blank / 159 / 148 / 85
TOTAL / 402 / 422 / 294
Q9)
Patients who had either a Hysteroscopy or Hysteroscopy with Biopsy Procedure in OutpatientsApr to Dec 2013 / 12/13 (April 12 to Mar 13) / 11/12 (Apr 11 to Mar 12)
Count of CaseNoteNo / Count of CaseNoteNo / Count of CaseNoteNo
Grand Total / 218 / Grand Total / 264 / Grand Total / 118
Attended / 218 / Attended / 264 / Attended / 118
DNA / 0 / DNA / 0 / DNA / 0
FOI Applicant Feedback
Maidstone & Tunbridge Wells NHS Trust constantly reviews the services that we provide in order to ensure that we deliver the highest quality possible to our service users. In order to assist with this process we would ask you please to take a couple of minutes to provide us with some feedback with regard to the FOI service that you have been provided.
FOI Request reference NumberDid you find it easy to make a request for information? / Yes / No
Did you receive an acknowledgement within a reasonable timeframe? / Yes / No
Are you satisfied that your request was dealt within a timely manner? / Yes / No
Did the response content address the requirement of your request? / Yes / No
What if anything do you feel the Trust could do differently to improve the FOI service for the benefit of our service users?
Please send this completed form to:
or
G Spinks
Head of Information Governance
Maidstone & Tunbridge Wells NHS Trust
Maidstone Hospital
Hermitage Lane
Maidstone
Kent ME16 9QQ