Ipswich Pilot Site – Action On Urology
GUIDELINES FOR A DIRECT REFERRAL RAPID
ACCESS TESTICULAR INVESTIGATION CLINIC
A DIRECT REFERRAL RAPID ACCESS TESTICULAR INVESTIGATION CLINIC INCORPORATING
General Practitioners [GPs] in East Suffolk are currently able to refer a patient directly to the Ipswich
Hospital Trust Diagnostic Imaging Department for a testicular ultrasound scan but there is often a
considerable delay before the scan is performed. GP’s are then informed of the result by fax/mail and the
patient may then be required to return to the surgery for the result. Any secondary care
opinion/involvement then needs to be arranged, resulting in further delay for the patient. Patients with
testicular/scrotal conditions who are currently initially referred directly to a Senior Urologist and seen in
the Outpatient Clinics, may be sent to the Diagnostic Imaging Department for an ultrasound scan and
return to the Outpatient Clinic for results and discussion of future management. This process involves the
patient attending 2 different departments on 3 occasions in addition to their initial GP visit. This secondary
care process may be undertaken on the same day if there is a high indication or suspicion of malignancy.
Alternatively patients may be informed of the result by letter thus causing the whole process from referral
to diagnosis to be a lengthy one.
The present systems are neither providing a good quality service for the patient nor utilising health
resources efficiently. We therefore wish to redesign the pathway for this patient group in order to achieve
a more rapid and simpler route to diagnosis and possible treatment.
Our aim is to establish a new dedicated service for patients with testicular/scrotal conditions who require an ultrasound scan.
Objective of Protocol
Men, who are referred by the GP for investigation for a testicular/scrotal condition, will be reviewed in a joint Sonographer and
Urology Nurse Specialist [UNS] clinic. However, it is planned that this service will ultimately be conducted by one generic
health professional. This will be a rapid access clinic with the service provided entirely within the Urology Dept. The service
will run concurrently with established Urology Outpatient Clinics where a Consultant Urologist is in attendance and is available
to offer immediate clinical review.
Aims of the Direct Referral Rapid Access Testicular Investigation Clinic Incorporating Ultrasound
A protocol based service to:
1. Review and examine suitable patients with testicular/scrotal conditions and feedback to the referring clinician.
2. Provide advice on symptomatic problems.
3. Provide an access route for further required interventions
4. Facilitate referral to and liaison with other multidisciplinary team members regarding social, physical and psychological
Rationale for the recommendations
The joint sonographer and UNS service will offer the following benefits:
The patient will have a consultation, ultrasound scan, be reviewed with results and where necessary, have an
agreed management plan on a same day visit.
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Ipswich Pilot Site – Action On Urology
The patient will be educated on testicular/scrotal conditions, self-examination and be given
information/sent literature where appropriate.
Reduce the demand on Outpatient Clinics and Diagnostic Imaging Dept.
Reduce the number of patient visits to the Outpatient Dept., Diagnostic Imaging Dept. and GP surgeries.
Financial savings to Hospital Trust by reducing transport costs for clinic visits.
Patient has convenience of one-stop service.
Reduction in clerical and administrative time.
Mode of referral to the Direct Referral Rapid Access Testicular Investigation Clinic Incorporating
GP's will be made aware of the service and will be asked to make referrals for patients requiring investigation into
testicular/scrotal conditions to the appointed clinic on the appropriate referral form.
Scrotal sebaceous cysts
Children under 16 years of age
Adult men with testicular/scrotal swellings requiring investigation with Sonography.
Adult men with testicular discomfort.
All patients who fulfil the referral criteria will be seen in the clinic unless they or the referring GP specifically request otherwise.
Method of referral
Patients are booked into the joint clinic by the Hospital Call Centre. The patient will be sent a letter asking them to contact the
Call Centre at the appointed time to make an agreed appointment to attend the clinic. If they do not wish to attend the clinic for
whatever reason, the referring GP should be informed in order that appropriate action can be taken.
Guidelines for Conduct of UNS in Direct Referral Rapid Access Testicular Investigation Clinic
Consultation and physical examination by UNS prior to Sonography.
Identification of any symptoms or concerns regarding the patient’s condition.
Consultation outcomes discussed with patient.
Education of patient regarding their condition through the provision of written/verbal information.
Education of patient regarding self-examination.
Consultation, results and management entered on record form and faxed/mailed to referring GP.
The nurse will initially, review all protocol outcomes with the Lead Clinician in the Urology Outpatient Clinic, which will be
running concurrently. However, this is envisaged as a short-term governance measure, which will be, reviewed when there is
adequate data available to evidence the outcomes from the service.
Referral to or discussion with Consultant:
[Initially all patients]
1. Where urgent intervention is required.
2. Where malignancy is suspected.
3. Where treatment option is uncertain.
4. Where UNS or Sonographer wish for Urologist opinion.
Patient time slots are set at 30 minutes per patient. A standard Hospital appointment letter will be sent to each patient with
details of the date and time.
Guidelines Direct Referral Rapid Access Testicular Investigation Clinic Incorporating Ultrasound
1. GP referral letter is filed in Urology Dept. Where Secondary care intervention is required, referral letter copied and filed in
patient hospital notes.
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Ipswich Pilot Site – Action On Urology
2. Patient would have been asked to contact the Call Centre to arrange an agreed clinic appointment and letter verifies this.
3. If patient fails to attend their appointment, a letter will be sent to the GP advising them that the patient has been
discharged and if required, a new referral form will need to be completed
4. Record details of consultation on record form. All entries initially, to be countersigned by a Urology Consultant.
5. Record form forwarded to referring GP and only copied and filed in Hospital case notes if secondary care intervention is
6. Initially, Urology Consultant to write letter to GP.
Clinical Audit Standards derived from guideline
The supervising Consultant in the Urology Outpatient Clinic that will be running concurrently with the joint clinic will oversee
this service. The Clinical Audit Department will be involved to ensure that a high level of patient satisfaction is achieved and
maintained and that the service is safe and effective using the following standards:
100% of suitable patients are satisfied with the rapid access service.
Outcomes are monitored by Urology Consultants.
Patients unsuitable for the joint service are identified and an alternative appointment is arranged.
Underpinning knowledge and competencies
The joint Sonographer and UNS service has been developed in consultation with the Consultant
Urologists, GPs, Ultrasonography Dept and the UNS. The development of this service involves training
and education in the care of patients with testicular and scrotal conditions. Experience and knowledge is
to be gained through nursing appropriate patients in the Urology Department, attending clinics in
Outpatient Dept, Sexual Health Dept and Diagnostic Imaging Dept and observing operating theatre
sessions with the Urologists. The UNS will attend a minimum of 20 clinic appointments with the
Consultant Urologists, to review patients with testicular and scrotal conditions. The supervising
Consultant must be satisfied that an acceptable level of competence has been achieved by the UNS
undertaking the joint service in the following areas:
Knowledge of the anatomy and physiology of testes and scrotum.
Understanding and knowledge of testicular/scrotal conditions.
Knowledge of management of conditions.
Effective communication with patients and provision of verbal and written information.
Ability to identify problems at consultation and arrange necessary investigations and consultant
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