Stockport PCT
Stockport NHS Trust
Tameside and Glossop PCT
Tameside and Glossop
Acute NHS Trust
INNOVATIONS IN UROLOGY
Case Study Template
1. Service Improvement
Catheter care in the community
2. Date service change was implemented Tameside health economy - urology
nurse led service commenced summer
2003.
Rapid response Tameside and Glossop
PCT Service- November 2004.
Stockport PCT service- commenced
February 2005.
3. Is the change still in place? Tameside- this service was undertaken
by the urology nurse specialists in a
community setting. The service
undertaken by urology nurse specialists
was suspended this summer due to
reduced staffing levels. This caseload
was taken over by the rapid response
team of Tameside and Glossop PCT in
November 2004.
In both pathways patients’ access to this
care pathway is initially following an A&E
attendance. A review will take place to
access the viability of additional access
points into the care pathway.
In the Stockport health economy patients
are admitted to Stockport NHS foundation
trust as an emergency or electively. The
community continence team already
undertakes a small number of trial without
catheter procedures. As from February
2005 the district nursing service has
undertaken trial without catheter.
4. Summary of change
Tameside & Glossop health economy: Patients that present to A&Ey with acute urinary
retention are assessed against an agreed protocol. Patients who fit this protocol are discharged
into the care of the PCT’s rapid response team who will undertake catheter care for these
patients in addition to performing a trial without catheter. All patients are then referred directly
to urology department, where different care pathways are followed dependent on the outcome
of the trial without catheter. Patients who do not fit the protocol at A&E are transferred to a bed
within Stepping Hill Hospital under the care of a urological surgeon through an agreed protocol.
Stockport
A similar process is in place within this health economy. Following an A&E attendance patients
will be discharged into the care of a team of district nurses. This group is now looking at other
access points to the care pathway from GPs direct, ambulance service and out of hours
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Stockport PCT
Stockport NHS Trust
Tameside and Glossop PCT
Tameside and Glossop
Acute NHS Trust
INNOVATIONS IN UROLOGY
Case Study Template
providers.
5. Why the change was undertaken
Tameside & Glossop health economy: A urology in-patient service is not available at
Tameside General hospital, patients attending with acute urinary retention were initially
Admitted under the care of the general surgical team. The process was then modified so that
Patients were transferred to Stepping Hill Hospital to be under the care of a urological surgeon.
This care pathway was then debated between urological, medical and nursing staff to identify a
More patient focused pathway. The next development of this pathway was for the urology
nurse specialists to undertake a trial without catheter within the patients home- this was run
successfully , but was suspended this summer following staff sickness and a vacancy This
team focused on the delivery of immunotherapy and chemotherapy.
Stockport health economy: The plan for the development of this service was to develop the
service within Tameside and then bring this service to the Stockport health economy. In the
meantime this group of patients were identified as part of a bed utilisation review that took place
within Stockport NHS Foundation trust, some of these patients were coded as ‘inappropriate
and not inevitable’ for admission purposes. Work was being undertaken in both the acute
providers and PCT’s to reduce the number of patients being admitted as emergency medical
admission. The PCT is also developing alternative care pathways for patients who do not
clinically need to attend A&E, for this group of patients this will be delivered early in 2005 from
this project.
Patient feedback noted that being admitted, as an emergency can be traumatic. Emergency
admissions also have a knock on effect on the ability of the acute trust to deliver their elective
workload. Patients and carers also confirmed that they would prefer to have this period of
care within their home setting.
6. Impact of change on the patient pathway.
Patients are able to have their trial without catheter undertaken in their own home environment
rather then being admitted as an emergency to an acute sector hospital. Please see attached
TWOC protocol, also AUR protocol – community and AUR protocol - A+E.
7. How was the change achieved?
A multi-disciplinary team was brought together, spanning both primary and secondary care
providers to address the issue at hand. In Tameside and Glossop district nursing leads
identified that this could be delivered by part of the district nursing service. The rapid response
team was identified, as they were a small team of specialist district nurses that worked across
the PCT. The rapid response team underwent a theoretical training session (1.5hours approx.),
led by the urology nurse specialists and practical bladder scanning experience (1-2 clinics)
within the outpatient setting. The existing A&E protocol was reviewed and referral pathways
developed and agreed. Clinical staff identified that patient care could also be improved with
patients leaving A&E with catheter supplies, as the lack of the relevant supplies could soon
become an emergency situation for the patient. Not all district nursing staff can prescribe
catheter supplies, so often a GP prescription was needed. Patients need to have taken 3 doses
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Stockport PCT
Stockport NHS Trust
Tameside and Glossop PCT
Tameside and Glossop
Acute NHS Trust
INNOVATIONS IN UROLOGY
Case Study Template
of an alpha-blocker prior to their trial without catheter, ensuring that this medication was given
at A&E would ensure that the trial without catheter could be undertaken, without delay. This
idea was suggested by primary and secondary care nursing leads, as it can cause additional
workload for the nurse, and delay the procedure which means that patients can have a catheter
in for longer.
8. Workforce changes related to the service change.
Rapid response staff and district nurses have been trained and deemed competent to
undertake trial without catheter. Nurses utilised in this development were already competent in
male catheterisation.
9. Challenges and lessons learnt in implementing the change
As part of this multi-department working we developed protocols to manage haematuria and
renal colic patients who present to A&E.
10. What was the impact on other services?
This scheme impacts on pharmacy services, as additional medication needed to be stocked in
the A&E medication supplies, this previously would have been prescribed by the GP. At this
stage there are no costs incurred as the needed medication has been provided. This will be
reviewed and included in the formal business case, with the pharmaceutical company also
being asked to extend their service.
The impact on district nurses/rapid response was calculated to include medical intervention
time and travelling, and Action On monies have been used to facilitate this change. This will be
picked up in business cases/ LDP processes as money spent on an A&E attendance or
emergency medical admission would have been much greater than the additional district nurse
time.
This scheme had different impacts on A&E departments, work patterns have been developed to
ensure that these patients are managed correctly and without delay. A&E has been used as
the first entrance point into this care pathway as a significant portion of these patients attend via
999.
11. Cost of the service change
Business case will be available from Clare Watson and Carol Richardson (emails:
claire.watson@stockport-pct.nhs.uk and c.richardson@nhs.net ).
12. Measurements of success
13. Impact to staff
Description of impact Measurement method
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Stockport PCT
Stockport NHS Trust
Tameside and Glossop PCT
Tameside and Glossop
Acute NHS Trust
INNOVATIONS IN UROLOGY
Case Study Template
a. Staff satisfaction Survey- Spring 2005. (A&E, district
nursess, urology, GP’s). GP comments
(referrals management and
modernisation forum)
b. District nurse competencies
c. District nursing protocols
d. Urology ward staff
e. GP’s
14. Impact to patients
Description of impact Measurement method
a. Information Patient survey validated at urology
users group, notes available on request.
b. Numbers of patients accessing the service, Data for Tameside available monthly
number of medical emergency admissions and from clare.watson@stockport-
number of patient benefiting from service pct.nhs.uk
Data for new service in Stockport
available monthly from
marionelaine.gilchrist@nhs.net
c. Patient journey Patient survey will be available from the
above from spring 2005
15. Impact to service delivery
Description of impact Measurement method
a. Number of emergency medical admissions Data available as above
prevented
b. Number of urology nurse specialist slots freed. Data from lynn.nuttall@stockport.nhs.uk
c. Number of bed days saved Data from lynn.nuttall@stockport.nhs.uk
d. Impact on operation cancellations Data from lynn.nuttall@stockport.nhs.uk
16. Impact to clinical outcome
Explain improved clinical outcomes for patients
Description of impact Measurement method
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Stockport PCT
Stockport NHS Trust
Tameside and Glossop PCT
Tameside and Glossop
Acute NHS Trust
INNOVATIONS IN UROLOGY
Case Study Template
a. % of successful trial without catheters Audit will be completed and submitted
to BAUS for a poster:
b. Infections due to catheter gerald.collins@stockport.nhs.uk.
c. Number of admissions following community Available from:
pathway lynn.nuttall@stockport.nhs.uk
17. Insert any additional comments relevant to this service change that are not included
above
The service will evolve as we are currently developing pathways that allow the entire care
pathway to be developed within a primary care setting, which includes access from out of hours
providers, Greater Manchester ambulance service and from GPs directly. Contact Clare
Watson clare.watson@stockport-pct.nhs.uk for the final business case and final agreed
pathways and protocols.
Contact Details-
Lead Person Carol Richardson- Primary Care
Gerald Collins- Consultant Lead
Telephone Contact Number 0161 304 5300
0161 483 1010
e-mail address c.richardson@nhs.net
gerald.collins@stockport.nhs.uk
Organisation involved Stockport Primary Care Trust, Stockport
NHS Foundation Trust, Tameside General
Hospital and Tameside and Glossop Primary
Care Trust.
Strategic Health Authority Greater Manchester
Area
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