Redesign of Patient Pathway for the management of Acute Retention of Urine
| Description | Streamlining of patient’s journey when presenting in Accident & Emergency (A&E) with the definitive diagnosis of acute retention of urine (ARU). |
|---|---|
| Setting | Department of Urology, Rotherham General Hospital NHS Foundation Trust. |
| Populationting | Male population with ARU. |
| Intervention summary | The patient is assessed in A&E and catheterised. They are offered the support of the district nurse. The patient is seen the next working day by a clinical nurse specialist (CNS) in urology and given a comprehensive urological assessment. A management plan is implemented including a trial of micturition and a two week supply of alpha blocker drugs. |
| Outcome Summary | Patient management plan is completed within a maximum of 72 hours, without an inpatient stay. |
| Startup Cost | £7500 |
| Running Cost | The project incorporated into the current roles of CNSs, so there was no increase in cost of consumables. The project reduced costs of inpatient stay. |
| Funding | Initially supported by NHS Modernisation Agency, Action on Urology with a grant of £7500. The grant was used to provide cover for the CNSs to develop the project. |
| Started | November 2004 |
| Ended | March 2005 |
| Location | Rotherham, England |
| Contact |
|
Background
We aim to streamline the patient’s journey when presenting in either Accident & Emergency (A&E) or the admissions ward with the definitive diagnosis of acute retention of urine (ARU). It has improved the assessment and management of patients with ARU and utilised hospital beds efficiently by reducing the need for an inpatient stay for ARU. It has improved the assessment strategy including diagnostics whilst encompassing the skills of the clinical nurse specialist (CNS). The patient management plan is completed within a maximum of 72 hours, without an inpatient stay.
What is the problem you are trying to solve?
Previously, following catheterisation to relieve ARU, patients were admitted onto a ward. A snapshot audit highlighted that the patient could be hospitalised for up to seven days whilst waiting for a urological opinion with regard to their further management. We have therefore streamlined and improve the service to enhance patient care and reduce the need for an inpatient stay for ARU.
What local organisations are involved?
Rotherham General Hospital; Department of Urology; A&E Department; Emergency General Surgical team; Rotherham Primary Care Trust (GPs and District Nurses); and Supplies Procurement.
How many people are running this project and who are they?
Mr BT Parys, lead clinician urological services; Mr I Edhem, consultant urologist; Mr Z Abbasi, Consultant Urologist; Mrs Jan Farrell, Department Manager/CNS Urology; Ms Denise Foulds, CNS Urology
What local population are you targeting?
The male population of locality. Rotherham’s total population is currently 250 000.
How many people are you targeting?
Average of four to six patients per month
Interventions
What interventions are you using to address the problem?
The patient is assessed in A&E on presentation with ARU. Once a definitive diagnosis of ARU is made, the patient follows the pathway. They are then catheterised, and sent home with catheter in situ. They are offered the support of the District Nurse. The patient is seen the next working day by a urology CNS who gives them a comprehensive urological assessment. A management plan is implemented, including a trial of micturition and a two week supply of alpha blocker drugs.
Is the project design based on evidence? If so, please state reference.
No.
Outcome
What outcomes or planned outcomes are you measuring?
• Effective management of ARU;
• Reduction in need for inpatient stay;
• Reduction of inappropriate Prostate Specific Antigen testing;
• Four hour A&E target wait; and
• Improved patient satisfaction.
Do you have any outcomes or results yet? If so, what are they?
A complete analysis of the project was presented at the Action on Urology Conference in Birmingham in November 2005.
An independent audit of the project was completed by a medical student from Sheffield University. This was a retrospective audit of all patients (total 40) following the pathway between November 2004 and March 2005. Outcomes from the audit indicate that the redesign of pathway for patients presenting with ARU is feasible and effective. The pathway has been reduced from six weeks to 72 hours maximum. The new pathway has relieved pressure on the Trust with regard to bed availability and employees’ time. There are also financial benefits to the Trust by the avoiding the need for hospitalisation.
For more information, see reference list 1 .
Is your project relevant to a government target or guideline?
In February 2004, the government introduced an incentive scheme, as part of an emergency access target, aimed at reducing waiting times in emergency departments. NHS trusts must ensure 98% of patients wait no more than four hours from arrival to admission, transfer or discharge.
Feedback
What obstacles did you have to overcome to set up this project?
Mainly communication between all the agencies involved to support the change in practice.
What have you learned about the project so far?
Men who present with ARU can be effectively managed within the outpatient setting, with decreased hospital costs.
What would you do differently?
Increase length of project time.