Date Published: November 29, 2018
Author(s): Clíodhna Browne, Catherine M. Dowling, Patrick O’Malley, Nadeem Nusrat, Kilian Walsh, Syed Jaffry, Eamonn Rogers, Garrett C. Durkan, Frank T. D’Arcy.
A combined urology clinic staffed by four consultants and four non‐consultant hospital doctors (NCHDs) was introduced in our institution in October 2015. This clinic is supported by a pre‐clinic radiology meeting and a synchronous urology clinical nurse specialist (CNS) clinic with protected uroflow/trial of void slots. Herein, we report on the outcomes of this clinic in comparison with the standard format of urology outpatient review.
We carried out a retrospective review of clinic attendances from May to July 2016. We recorded the number of new and return attendances, which team members had reviewed the patient and patient outcomes. We also calculated the waiting times for new patients to be reviewed in the outpatient clinic.
The combined urology clinic reviewed an average of 12 new and 46 return patients per clinic. The standard urology clinic reviewed an average of 8 new and 23 return patients per clinic. 54% of patients were seen by a consultant in the combined urology clinic, and 20% of patients were seen by a consultant in the standard urology clinic. The rate of patient discharge for new patients was 14.8% in the combined clinic compared to 5.9% in the standard clinic. Overall patient outcomes are outlined in the table. The waiting time for review of new patients in the combined clinic was reduced by 39% from 144 days to 89 days over a one-year period.
The introduction of a combined urology outpatient clinic with the support of pre‐clinic radiology meeting and synchronous urology CNS clinic facilitates patient discharge.
Urology is a speciality with a large volume of outpatient work. Hospital outpatient services make up a significant proportion of urologists’ working hours. Manpower and workforce crisis issues have a significant impact on outpatient services in our hospitals. The British Association of Urological Surgeons (BAUS) has produced guidelines that suggest ideal clinic numbers and outline the proportion of the working week that should be dedicated to outpatient clinics. In many urology departments, these numbers are not adhered to, due to long outpatient waiting lists and unfilled consultant posts. It has been suggested that a comprehensive combined “one-stop” clinic review, incorporating imaging and endoscopy, would facilitate discharge of patients after one clinic visit.
We carried out a retrospective review of clinic attendances from a representative time period after pilot introduction of the combined clinic (May to July 2016). We recorded the number of new and return attendances, which team members had reviewed the patient and patient outcomes. We also calculated the waiting times for new patients to be reviewed in the outpatient clinic. These outcomes were compared to the clinic attendances at the standard urology clinic over the same time period.
Manpower and workforce crisis issues have a significant impact on outpatient services in Irish hospitals. The British Association of Urological Surgeons (BAUS) guidelines suggest ideal clinic numbers of eleven new patients and fifteen return patients per consultant per outpatient clinic . In total, combined new and review patients should be limited at 12 patients per consultant per clinic. BAUS recommends allocating twenty minutes per consultation for new patients and two to fifteen minutes per consultation for review patients. Complex patients referred for specialist opinion should be allocated thirty to forty-five minutes per consultation. These numbers are rarely adhered to in practice due to restrictions on clinician time and prohibitively long waiting lists. Indeed, the clinic numbers reported in this study significantly exceed these recommended numbers.
The introduction to our department of a combined urology outpatient clinic with the support of pre‐clinic radiology meeting and synchronous urology CNS clinic has facilitated patient discharge and enabled prompt senior decision-making for our outpatients. The presence of a senior decision-maker results in more consultant-led care and facilitates patient discharge. The introduction of same-day imaging and endoscopy would likely further improve outpatient clinic efficiency.