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Use of Emergency Theatre by the on call Urology team Project number # 2010

Clinical Audit Report. Use of Emergency Theatre by the on call Urology team Project number # 2010. Surgery / Urology. Dr Ahmed Ibrahim , Registrar, Audit Project Lead Mr Chris Dawson , Urology Consultant, Clinical Audit Lead. 01/05/2018 - 30/07/2018. RHD 30 th October 2018. Audit team.

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Use of Emergency Theatre by the on call Urology team Project number # 2010

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  1. Clinical Audit Report Use of Emergency Theatre by the on call Urology teamProject number # 2010 Surgery / Urology Dr Ahmed Ibrahim, Registrar, Audit Project Lead Mr Chris Dawson, Urology Consultant, Clinical Audit Lead 01/05/2018 - 30/07/2018 RHD 30th October 2018

  2. Audit team

  3. Background • Urological emergencies represent 2.2% -5.8% of all urological emergencies. • India 2013 : The commonest presentation of emergency urology patients was renal colic (24.2%) followed by acute retention of urine (14.7%), obstructive uropathy (14.7%), haematuria (9.9%), Lower Urinary Tract Symptoms (LUTS) with Urinary Tract Infection (UTI) (9.8%) .

  4. Project’s aims and objectives • NCEPOD 2003 showed that 4% of Urology surgical caseload overall was performed out of hours. This audit aims to assess the impact of moving the emergency work from HH to PCH on the emergency Urology workload

  5. Turkey 2

  6. 4.8 % required surgery

  7. Ireland 2012/13 • 752 cases

  8. France 2009 • 1257 patients consulted in this unit • Main diagnoses were acute urinary retention (24.1%), renal colic (17.42%), urinary infections (22.1%), postoperative complications (11.2 %), symptomatic benign prostate hyperplasia (5.2%) . • The treatment was surgical in 213 (17.7%) cases.

  9. Audit standard(s)

  10. Methodology • Retrospective study from 1/3/2017 -28/2/2018. • All emergency surgeries done by the urology team in Emergency theatre • Data divided into “Pre merger with Hinchingbrooke Hospital” and “Post merger with Hinchinbrooke” • Clinical notes, databases used, questionnaires, interviews, observation

  11. Data collection pro-forma Please see spreadsheet submitted separately

  12. Key Findings • 330 emergency cases • Age : 3-92 years • Mean age: 44.7 years

  13. Urology Emergency Workload compared to other Specialties

  14. Type of Case by number

  15. Number of operations by Surgeon type

  16. Results • 0-4 operation /day • 28 cases (8%) done after midnight

  17. Discussion • The findings were presented to the Urology Clinical Governance ½ Day meeting, and this formed the basis for the recommendations and action plan • 8% of Urology Emergency cases were performed after midnight, and thus the audit is not compliant with the departmental standard • The data confirms what was felt by the Urology department, i.e. that the emergency workload has risen significantly since the Merger with Hinchingbrooke Hospital • One reason for this (but not confirmed) is that emergency cases that where hitherto going to Addenbrookes are now ending up in Peterborough – anecdotal evidence from our Addenbrookes Hospital colleagues would suggest this to be a factor • A large proportion of the emergency Urology cases involves insertion of ureteric stents

  18. Discussion • Possible strategies for reducing this portion of the emergency workload include • Audit of GFR following renal colic presentation (This could potentially lead to a reduction in the number of patients undergoing stent insertion) • Appointment of two more Urology Consultants • Introduction of Primary Ureteroscopy for stone patients (could reduce the number of patients requiring stent insertion) • Introduction of Tuesday Emergency List • Depending on Urology service provision, this audit may be suitable for re-audit in 2019.

  19. Project outcome

  20. Actions to be taken

  21. References • 1- Talreja, Shyam et al. “A Spectrum of Urological Emergency Reported at a Tertiary Care Teaching Hospital: An Experience.” Journal of Clinical and Diagnostic Research : JCDR 9.11 (2015): PC12–PC15. PMC. Web. 16 Sept. 2018. • 2- Topaktaş, Ramazan et al. “Retrospective Evaluation of Urological Admissions to Emergency Service of a Training and Research Hospital.” Turkish journal of urology 40.4 (2014): 216–220. PMC. Web. 16 Sept. 2018. • 3- Redmond EJ , Forde JC, Abdelrahman MA, Kelly NP, Akram C, Giri SK, Flood HD. A prospective audit of emergency urology activity in a university teaching hospital. Ir J Med Sci. 2015 Jun;184(2):493-7.

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