INNOVATIONS IN UROLOGY

                                                Case Study Template

1. Service Improvement
Holistic bladder cancer care pathway

2. Date service change was implemented                     Jan ‘04- haematuria clinic protocol

                                                           Feb ‘04- protocol cystoscopic follow up of
                                                           patients with bladder cancer

                                                           June ‘04- GP notification of a serious

                                                           Aug ‘04- partial booking for IVU’s

                                                           July ‘04- formal patient focus group

                                                           July/Oct ’04- full booking for IVU’s

                                                           Aug ‘04- Informing patients of a
                                                           superficial bladder cancer diagnosis at

                                                           Sept 03/Oct ‘04- ultrasound scan on
                                                           same day as haematuria clinic.

                                                           Nov ‘04- full booking of first outpatient
                                                           appointment and 1st treatment.

3. Is the change still in place?                           Jan ‘04- haematuria clinic protocol- run by
                                                           urology nurse specialist at one site,
                                                           awaiting appointment of new nurse
                                                           specialist to complete the service at the
                                                           second site.

                                                           Feb ‘04- protocol for cystoscopic follow
                                                           up of patients with bladder cancer.

                                                           June ‘04- GP notification of a serious
                                                           diagnosis. GP’s informed within 24hours,
                                                           clinicians dictate an urgent tape, the
                                                           resultant letter is faxed to the relevant
                                                           practice and confirmation of letter delivery
                                                           is gained by secretary.

                                                           Aug ‘04- partial booking for IVU’s. If an
                                                           IVU was required then the urology dept
                                                           would give the patient a letter (in clinic)
                                                           asking them to contact the radiology dept
                                                           within 3 – 4 days to make an appt. At this
                                                           point basic questions were also asked in
                                                           line with IRMER regulations etc,

                                                           July ‘04- formal patient focus group.
                                                           Group will meet once a year to review
                                                           changes and guide future service
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                                           INNOVATIONS IN UROLOGY

                                                Case Study Template


                                                           July/Oct ’04- full booking for IVU’s.
                                                           Request written by medical staff, and
                                                           given to patient who walks around to the
                                                           radiology department and agrees a date
                                                           for this investigation. (IVU bookng
                                                           protocol attached)

                                                           Aug ‘04- informing patients of a
                                                           superficial bladder cancer diagnosis at
                                                           home. Consultant informs nurse
                                                           specialist who arranges to visit the patient
                                                           at home to inform them of the diagnosis.
                                                           The nurse specialist then agrees a
                                                           treatment plan, following consultant

                                                           Sept 03/Oct ‘04- ultrasound on same
                                                           days as haematuria clinic. Once an
                                                           appointment is negotiated with a patient,
                                                           urology will inform radiology of these
                                                           times. (There are 5 slots per session - 2
                                                           sessions per week). Patient will attend
                                                           radiology for their ultrasound scan and
                                                           take their results straight round to urology
                                                           where the medical team will utilise the
                                                           findings of the ultrasound scan with the
                                                           rest of their assessment (See attached
                                                           ultrasound protocol)

                                                           Dec ‘04- Full booking of first outpatient
                                                           appointment and 1st treatment.
                                                           Following the receipt of a 2 week
                                                           proforma the patient will be contacted by
                                                           the urology dept, up to 3 occasions (one
                                                           outside of normal working hours) in order
                                                           to agree a first appointment. Should the
                                                           urology dept not be able to contact the
                                                           patient an appointment will be sent out.
                                                           Following a decision to list a patient for
                                                           first treatment the clinician will agree a
                                                           date with the patient. (See attached
                                                           suspected cancer booking)

4. Summary of change

The patient journey has been streamlined; the majority of changes have involved diagnostics.
These changes have involved: urology nurse specialists, consultant urologists and
radiographers, superintendent radiographers, operational managers in urology and radiology,
medical record staff and the cancer services collaborative team.

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                                           INNOVATIONS IN UROLOGY

                                                Case Study Template

5. Why the change was undertaken

The urology department wished to further develop their nurse led services in the treatment and
management of bladder cancer. This was to train additional staff and further develop services
which could be provided within the patient’s home. Additional staff were trained but have
subsequently left the department, new staff will be trained by April ’05.

National cancer standards and patient feedback have been the guiding influence in the
development of bladder cancer services, this is linked in locally with the joint strategy group for
Stockport, which ensures that developments span the primary/secondary care interface.

6. Impact of change on the patient pathway.

See attached before and after pathways.

7. How was the change achieved?

This project bought together all staff involved in the bladder cancer patient journey for the first
time in one room; this allowed the development of a process map. This allowed staff to be
aware of the entire patient journey not only the part that they are actively involved in. This led
to a number of areas for development which were agreed and catalysed by the cancer services
service improvement facilitator.

This project allowed partial and full booking systems to be developed by both radiology

Urology was the first department to implement notifying a GP within 24 hours of a serious
diagnosis being given.

The group worked together to solve problems that arose, which has led to very practical and
implementable solutions being successfully implemented.

8. Workforce changes related to the service change.

Job description of urology nurse specialist at Tameside available from

9. Challenges and lessons learnt in implementing the change


Getting all personnel together to develop the process map proved invaluable, as staff were
made aware of the entire patient journey.

Keeping people focused on their parts of service development proved a challenge; this was
managed by regular meetings and 1 to 1 meetings and updates with the service improvement

Radiology department requested Service development skills, including as process mapping,
which was provided by the project manager.

Shadowing a patient through the initial journey would have been very powerful rather than
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following their journey on paper; this will be implemented on future projects led by the service
improvement facilitator.

Access to relevant data has been challenging; a lot of time has been spent with manual data
collection, as information departments did not collect this needed information.

10. What was the impact on other services?

This project has been very useful in both radiology departments in developing fully booked
systems. Having the close relationship with urology has allowed practical systems to be
implemented. This has reduced the DNA rate
11. Cost of the service change

This project has not incurred and additional expenditure. Urology outpatient slots have been
saved due to changes made in the scheduling of radiology investigations.

Additional cystoscopy equipment was needed locally, but this was to replace old equipment and
ensure that images seen through the ‘scopes could be recorded, as part of clinical governance

12. Measurements of success

13. Impact to staff

Description of impact                                        Measurement method
 a. Staff satisfaction                                       Questionnaire. The radiology manager
                                                             commented- ‘that this process had
                                                             greatly reduced administration’, which
                                                             has had a great impact on staff morale.

 b. Radiology staff training                                 Information from:

 c. Haematuria protocols                                     Competency

 d. Cystoscopic follow up of patients with bladder           Clinic protocol attached
    cancer protocol

 e. Greater Manchester Cancer Network protocols              Available on request from

 f.   Reduction in waiting lists for IVU’s                   Audit; formal audit will be completed,
                                                             further information from

 g. Reduction in DNA’s and cancellations for                 Staff time sheets
    radiological investigations

 h. Working day lengthened for radiology staff

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                                            INNOVATIONS IN UROLOGY

                                                 Case Study Template

 14. Impact to patients

Description of impact                                        Measurement method
a. Patient questionnaire                                     Survey, results will be available in
                                                             March 2005, from

b. Patient focus group                                       Patient journey mapped and agreed
                                                             areas for development

c. Identical information given to patients across            Picked up by patient focus group.
   different sites                                           Agreed information given out at specific

d. Reduction in the number of visits to the hospital         Identified by process mapping, between
                                                             1 or 2 visits saved.

e. Number of patients passing through service                Very difficult to map, as so many
                                                             changes. Formal audit September
                                                             2005 will be available from:

f.   Cancer network patient involvement in the               Consistency throughout the whole
     development of new protocols and guidance               cancer network.

 15. Impact to service delivery

Description of impact                                        Measurement method
a. Full booking of IVUs and ultrasound                       Monitored by radiology departments

b. Full booking of 1st appointment and first                 Trust wide policy, monitored by cancer
   treatment                                                 services team and divisional general

c. GP notified of serious diagnosis                          Trust wide monitoring, and discussed at
                                                             Joint Strategy Group.

d. Number of patients benefiting                             Cancer Services Collaborative
                                                             monitoring, peer review

e. Adherence to 31 and 62 day cancer standards               Cancer Services Collaborative

f. Consultant out-patient slots saved                        Audit from patient notes

16. Impact to clinical outcome

Description of impact                                        Measurement method
a. Shorter time to diagnosis                                 Audit. Too small a number to audit post
                                                             change yet,

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                                           INNOVATIONS IN UROLOGY

                                                Case Study Template

b. Shorter time to treatment                                Audit. Too small a number to audit post
                                                            change yet,

c. More patient focused care                                Patient satisfaction survey, in progress

d. Patient involved in date of tests and treatment          Patient satisfaction survey.

Contact Details

Lead Person                             Angela Heer
Telephone Contact Number                0161 419 5580
e-mail address                
Organisation involved                   Stockport NHS Foundation Trust, Tameside
                                        and Glossop NHS Trust, Stockport PCT,
                                        Tameside and Glossop PCT
Strategic Health Authority              Greater Manchester

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