Please mark or highlight the appropriate box and add text where requested
Name of Hospital / Unit
Address
1.1 Does your Trust provide a dedicated OASI follow up clinic?
1.2 If yes, where is the clinic located?
1.3 If yes, how often does this clinic run?
1.4 What follow up schedule is used?
1.5 Which department oversees the clinic?
1.6 How soon after birth are patients first contacted regarding their injury?
2.1 Which professionals deliver care in the OASI clinic? Tick all that apply
2.2 Do you have a multidisciplinary or a joint clinic?
2.3 If no, do you have a pathway for escalation to colorectal, urogynae or mental health services?
2.4 Are staff members specifically trained in perineal trauma or anorectal investigations?
2.5 Do you use any validated assessment tools i.e. Wexner score, ICIQ-B? (please state)
3.1 Which of the following are used in the OASI clinic?
3.2 How is it decided which investigation(s) to perform?
4.1 If EAUS is performed within the perinatal period, at what stage(s) is EAUS performed?
4.2 If EAUS is performed as part of an OASI clinic, when is this performed?
4.3 Which grades of tears are offered EAUS?
5.1 What training/accreditation is required for EAUS operators within your trust?
5.2 Do you have competency standards assessments in place?
5.3 Is EAUS data routinely audited or reported?
5.4 Are there plans to expand / modify or implement EAUS services?
5.5 What are the perceived main barriers to EAUS provision within your trust?
