A survey of patients’ experience in Ambulatory Gynaecology Clinic Birmingham Heartlands Hospital Heart of England NHS Foundation Trust Karolina Palinska-Rudzka Susan Hartman Lindora Fenton Manjula Subramanian Kausik Das

Ambulatory Gynaecology Service in Birmingham Heartlands Hospital Established in December 2013 New procedures have been incorporated in the previously existing outpatient hysteroscopy clinics to establish the Ambulatory Gynaecology Service Many therapeutic procedures (endometrial ablation, polypectomy, minor vulval procedures) are now performed in the ambulatory gynaecology clinics which were previously done under general anaesthesia as a day case procedure Survey was performed to evaluate patients’ views on the newly developed service

Aim of the study Assessment of patients’ perceptions of the quality of ambulatory service To highlight positive aspects of ambulatory service To identify the areas that need improvement

Objective of the study To improve the service and patients’ satisfaction

Materials and methods Setting - Ambulatory Gynaecology Service @ Birmingham Heartlands Hospital A questionnaire was prepared and agreed by doctors, nurses and HCAs, using Likert scale A prospective survey of patients’ experience was carried out between June and September 2015

Questionnaire Likert scale is a psychometric scale commonly involved in research that employs questionnaires. Respondents specify their level of agreement or disagreement on a symmetric agree-disagree scale for a series of statements. For our survey we have devised a 6 point scale as below: Strongly agree Agree Uncertain Disagree Strongly Disagree Unable to comment

Questionnaire The following domains were asked in the questionnaire: Environment Communication Procedure Discomfort Recovery Discharge plan Overall experience Recommendation

Demographics In total 62 responses were obtained and analysed Age range 22-85 Age group 46-65 year old was the largest (~30%) 56% (35/62) were Caucasian

Hysteroscopy was the most commonly performed procedure (32) --- either on its own(18/62) or with insertion of Mirena coil(14/62). We did 12 cases of polypectomy with Myosure device and 3 cases of Endometrial ablation

ENVIRONMENT Q1. The waiting area was relaxed with usual facilities (water fountain , toilet, magazines, comfortable sitting facilities, clean, not too noisy) Q2. The changing room facilities were appropriate with adequate privacy and cleanliness Q3. The procedure room was of appropriate size and layout, clean and did not appear to be too cramped or noisy Q4. The recovery area was clean and appropriate with adequate privacy and facilities Q5. I have no concern with the environment of the clinic

COMMUNICATION Q1. Communication with the receptionist was appropriate and relaxing Q2. Communication with the nurses was relaxing and helpful Q3. Communication with the doctor was relaxing, informative and helpful Q4. I received appropriate verbal and/or written information before coming to the clinic Q5. The doctor explained clearly what is going to be done before the procedure Q6. My verbal/written consent was taken before the procedure Q7. I felt in control to decide the plan of the procedure agreed by me and the doctor Q8. Overall I have no concern with the communication of the whole team.

PROCEDURE Q1. The procedure did not appear to be overwhelming Q2. I felt in control during the procedure Q3. I could communicate with the staff Q4. Staff offered me constant support Q5. Staff listened to me and took notice of my concerns

DISCOMFORT DURING PROCEDURE Q1. I could communicate to the staff about pain Q2. My concern about pain was listened to and appropriate action taken Q3. Overall, I felt in control of the discomfort/pain Q4. I am happy with the care I received

RECOVERY Q1. I was kept comfortable during recovery Q2. I have no concern with the recovery after the procedure

DISCHARGE PLAN ‘Outcome of the procedure and discharge plan were clearly explained to me’

How likely are you to recommend our service to friends and family ?

OVERALL EXPERIENCE ’My overall experience was positive’

Free Comments-positive The staff were amazing. They tried to make me feel comfortable all the way through. Staff were friendly, informative and reassuring. My dignity was understood; great team. Clean , tidy , quiet and relaxing environment. Good communication and professionalism. I did not feel any pain during the procedure. Environment and cleanliness very good, nurses were wonderful. Very good recovery area. Great staff and support. Treated very kindly by doctors and nurses. Very efficient service. Very impressed with service and NHS. I was pleased with every aspect of my treatment. The nurses could not have been more helpful and understanding.

Free Comments- negative Had to wait for almost an hour. No water fountain! First visit wasn't explained - second visit, this one, explained. For such a personal matter, it would have been helpful to understand the role of each person present in the room. Otherwise a sensitive approach was taken which I appreciated very much. I was referred to the nurses as ‘she’. Not a problem but would have preferred to be referred by my name. It is only a personal observation but otherwise very good service.

Summary Some patients raised concerns with: recovery area and care during recovery information available before coming to the clinic consent taken (the usual practice is to take verbal consent) discomfort during procedure explanations of the outcome and discharge plan

CONCLUSIONS Majority of the patients were happy with the service In general patients were apprehensive about the procedures but found staff very supportive and the experience positive Some patients suggested: written information before coming to the clinic so that they are aware what to expect clearer explanation of the outcome and discharge plan Some patients asuggested we wcould improve our service byproviding

RECOMMENDATION To produce information leaflet for ambulatory gynaecology service (in progress) To look at the consent issue - move from verbal to written consent Clearer explanation of the procedure and discharge plan – copy of the letter to the patient? To look at the recovery area and care at recovery To repeat the survey in 6 months

Thank You