Post-menopausal Rapid Access Clinic Survey Emily Green Nurse Specialist Gynae Oncology December 2011
About you and your appointment 80 All of the ladies who had 70 been previously seen had 60 been by someone within 50 our team in Peterborough. Yes 40 No 30 20 10 0 % Referred before? 89% of the referrals were from GPs. The remaining were from other consultants within the Women’s Health Services. 57% reported concerns before attending the clinic. Of these, 75% said their main concern was pain. Other concerns included what would be found and embarrassment.
Pre-appointment information 100 90 80 70 60 Yes 50 No 40 N/A 30 20 10 0 % Received? % Understandable? % Adequate? • 86% of patients reported to have received information before the appointment and found it very useful. • The majority of the patients who did not receive information were those referred from the gynae clinic and therefore not on the normal referral pathway.
Outpatient organisation Early On time 85% of patients were seen Up to 20mins Up to 40mins within 20 minutes of their Up to 60mins >1hour appointment time. Left/Not seen • Only 18% of these patients felt they were given an apology/explanation as to why the clinic was running late. • 75% said that the department was easy to find. • 93% said the waiting area was comfortable.
Seeing the specialist 100 90 80 70 60 Yes 50 No 40 N/A 30 20 10 0 Understood Procedure fully Felt able to ask Felt listened Answered your Confidence in why referred? explained? Qs? to? Qs? Dr? Only 1 lady reported to not know why she had been referred to the service. 100% felt that they had confidence and trust in their specialist.
In the examination room… • 94% of ladies seen did not have anyone accompany them into the room. None of the ladies that came unaccompanied reported that they would have preferred to have brought someone into the room. 100 80 60 Yes No 40 N/A 20 0 Did what you were told at the consulation correspond to what actually happened during the procedure? • Reasons for the ladies feeling that the consultation was not accurate included that it was more painful than expected and that there was no explanation given until actually in the examination room.
Interventions performed USS Speculum Scope Intervention Biopsy Unsure N/A 0 10 20 30 When asked, no one reported that they would have preferred to have had two separate appointments for different investigations (ie time between USS and scope if required). Most reported to have given verbal consent for hysteroscopy but only 1 patient gave written consent. Worrying 2 patients said that they felt they were given no option.
Perception of pain during procedure 100% 90% 80% 70% N/A 60% Uncomfortable 50% Bearable 40% OK 30% 20% 10% 0% Below Ave Average Above Ave N/A Interesting that of those who thought their pain threshold was above average, none said that the pain was just OK – is this just a poorly worded question as it is open to interpretation? Would have been better to rate pain on scale of 1-10.
Analgesic/LA effect on pain perception Only 2 ladies thought that LA had been used for the procedure. 1 of these ladies rated the procedure quite uncomfortable whereas the other said that it was OK. 100% 90% N/A Women’s 80% perception of 70% Quite pain compared to 60% uncomfortable 50% analgesia taken Bearable 40% before 30% appointment: OK 20% 10% 0% Analgesia No taken analgesia
Dignified? 93% felt that every effort was made to preserve their dignity. The other 7% felt that there were more people in the room than needed and that the findings should have been discussed when they had redressed. 96% reported the changing facilities to be adequate, the only negative comment was that it was too small and that it was a toilet not a changing room.
After the procedure 100 90 80 70 60 Yes 50 No 40 N/A 30 20 10 0 Findings Understand Information on explained? explainations? complications? (Although only 61% reported to have received post-hysteroscopy information, more people have answered this quest than said they had a scope. 61% equates to 17 patients (out of the 20 who reported to have a scope), this is 85%.)
Any complications experienced? Only 32% of ladies reported to have experienced any kind of complication (even minor spotting). Minor spotting Heavy bleeding Minor pain Prolonged pain Severe pain Infection Other
Where did you seek advice on your complication? No one GP Womens Health Ward EGAU Womens Health Outpatients Other
When did you receive your results letter? 18 16 Was this 14 considered a 12 reasonable N/A 10 time frame No to receive 8 Yes the results? 6 4 2 0 <2weeks 2-3weeks 3-4weeks >4weeks N/A 100% of people who commented, reported that the results letter was understandable.
What patients thought we did well… ‘Most staff friendly and treated with courtesy’ ‘Staff in the scan room were very friendly and tried to ease a difficult situation, well done to them!’ 'I found the two nurses very friendly and one held my hand all through it and made me feel calmer. Well done nurses. The nurses were all I needed to calm me’ ‘I was very satisfied with the whole procedure’ ‘I felt very relaxed and comfortable. All staff I came in contact with were very polite and professional and made it a nice experience’ ‘The service, I thought was very good’
‘Doctor put me at ease. Two assistants were very helpful as I felt a bit embarrassed’ ‘Lady assistants made me feel at ease and were extremely nice’ ‘I found my consultant very easy to talk to’ ‘I had no questions. If I had, I felt I would have been listened to’ ‘The nurses were very reassuring and kind to me’ ‘Dr and nurses were all very helpful and caring’ ‘It was carried out by friendly staff, no embarrassment caused’
Which comments we could improve on? ‘Felt that the consultation was short, not sure that I can remember what was said’ I was told L.A would be used (but it wasn't). There should have been more explanation and information. I was very stressed throughout. ‘Could improve the time taken to get back the results letter’ ‘Consultation was performed whilst I was in the scan position and was undignified and whilst feeling vulnerable. I feel it would be better to be dressed’ ‘Would like to have had more of consultants time as it was complicated, needed more answers but it was lunch time and they were hungry. It was 12:50 so no one was around reception’
‘Would have preferred more info on the end result’ ‘Insufficient time for consultation, it was presumed I knew what was going to happen, without checking. Overall not a 'personal' experience. It felt too rushed’ ‘You discussed what was/not found, sitting more comfortable in a proper chair, not with my legs up in the air’ ‘Not enough seating. Noisy area from air con. Bland’ ‘Signage poor - no gynae sign. Waiting room very small’ ‘Changed in a toilet! Not good enough under the circumstances, the room was too small’
Action Plan Ddiscussed on 18 June Action plan – since this survey, changes have already taken place. Call Centre are aware to send information out with every hysteroscopy appointment. Hysteroscopy leaflets located in the clinics are more identifiable. The post-procedure information has been updated and is now being handed out by clinic staff. With time constraints it can be difficult to see patient to discuss findings once re-dressed. It was agreed to at least discuss findings when the patient is in a sitting position, rather than scan position
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