Severe Endometriosis should be treated in specialist centres and the BSGE will accredit centres where Gynaecologists work in appropriate clinical teams, audit their outcome and have sufficient workload to maintain their surgical skills. These principles are the foundation of the accreditation criteria listed below.
The requirements to be a BSGE Accredited Endometriosis Centre are:
1. A dedicated consultant lead endometriosis service run within a specialist outpatient clinic
This is a clinic, which is specifically devoted to endometriosis patients and accepts referral for this named condition. Ideally, it is recorded as such for any respective referrer; whether they be primary or secondary care clinicians. The clinic should be named The Endometriosis Clinic and advertise its referral criteria for use locally. The purpose is to ensure local patients are aware of the specialist clinic and the advantages it will offer them. There should be a lead consultant or team of consultants who run the service and these will be the named consultants accredited to run a BSGE Endometriosis Centre.
2. Workload
It is essential that there is sufficient workload throughput to maintain surgical skills for the most complex cases. Whilst all degrees of severity of endometriosis may be treated within the service, it is a requirement that at least 12 cases of rectovaginal endometriosis which require dissection of the para rectal space, are treated by surgery each year. This is defined by a procedure to remove rectovaginal endometriosis that requires dissection of the pararectal space and must be recorded on the BSGE database. Whilst this can include open surgery it is expected that this will usually be undertaken laparoscopically.
NB: Changes in criteria in 2017
Currently the requirement is for a minimum of 12 cases annually for each centre. From January 2017, this will change to 12 cases per gynaecological surgeon annually. So the accreditation for a centre with one named Gynaecologist will be 12 cases, whereas a centre with two Gynaecologists will be 24 cases, three would be 36 cases etc.
3. Supporting Surgeon
A named colorectal surgeon is required to support the service. It is expected that he/she will attend complex surgery involving the bowel and operate with the centres gynaecologists. The partnership will allow patients to receive the best advice, surgery and follow up where the pathology extends to the bowel.
4. Other supporting clinicians
A support network is required which includes urologists and pain management specialists who declare that they will provide active support to the service when needed. This may involve intra-operative support or outpatient support. It is expected that the names of consultants from these specialties will be recorded on the centres’ staff list.
5. Data collection
A written agreement from the lead Gynaecologist in the Centre that all cases of rectovaginal endometriosis (as defined by dissection of the pararectal space) will be entered on to the database, and will be followed up for two years post-surgery.
6. Endometriosis Specialist Nurse
Having an Endometriosis CNS is a requirement and improves the quality of the service for the patients.
Endometriosis specialist nurses should be banded at Agenda for Change (AFC) Band 7 or above, or as AFC Band 6 with a clear pathway to progress to AFC 7.
It is expected that each centre has a CNS with at least 15 hours per week protected time dedicated solely to the endometriosis CNS role.
The amount of protected hours would increase in line with the size/activity of the BSGE Endometriosis Centre and the number of specialist consultants within the service. Eg. For centres required to submit more than 24 cases annually it is expected that increased specialist nursing time is required, ideally minimum 1 whole time equivalent.
It is essential for Endometriosis CNSs to participate in professional development (CPD) within the field of endometriosis.
It is expected that the CNS attends the BSGE nurses’ day or BSGE Annual Scientific Meeting or an equivalent face to face update at least bi-annually.
A dedicated endometriosis nurse specialist clinic should be in place.
It is the expectation that patients should have access to appointments directly with the endometriosis CNS. However, it is acknowledged that some centres run joint clinics, whereby consultants and nurses see patients together.
The above points must be demonstrated as part of the annual re-accreditation process.
7. Submission of an exemplar video of surgery for laparoscopic excision of severe recto-vaginal endometriosis
Submission of an exemplar video of surgery for laparoscopic excision of severe recto-vaginal endometriosis that required dissection of the pararectal space will be a requirement from 2016. The video must be submitted by the end of April each year and will be viewed by the Scientific Advisory Group around the time of the Annual Scientific Meeting. The purpose is to ensure that cases being entered onto the Endometriosis database are consistent with what is expected.