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No. 204. Introduction of one stop haematuria clinic and its role in reducing waiting time for assessment and treatment of macroscopic haematuria. Melanie Hwang, Tony Beaven, Madhusudan Koya, Sue Osborne Department of Urology, Waitemata District Health Board, Auckland, New Zealand.

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No. 204

Introduction of one stop haematuria clinic and its role in reducing waiting time for assessment and treatment of macroscopic haematuria

Melanie Hwang, Tony Beaven, Madhusudan Koya, Sue Osborne

Department of Urology, Waitemata District Health Board, Auckland, New Zealand

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Results

Introduction

Protocol based haematuria clinics have been adopted at different centres with the primary aim to facilitate timely and accurate diagnosis of cancerous and non cancerous urological conditions. They have achieved varying success and local policies and facilities have been identified to play important roles in the feasibility of these streamlined care models.

A weekly one stop haematuria clinic (OSHC) was introduced at Waitemata District Health Board (WDHB) in New Zealand in August 2011, aiming to assess patients with macroscopic haematuria at a single clinic attendance.

Aim

This study attempts to understand the impact of OSHC on reduction in waiting time for investigations and treatment of macroscopic haematuria through a retrospective analysis of two groups of patients with macroscopic haematuria; those seen immediately before and after the introduction of OSHC.

Our primary outcome is the time taken to complete all basic investigations, defined as the period between the date of haematuria referral received and the date of last basic investigation performed.

The secondary outcome is the time taken for completion of all investigations, including basic as well as additional investigations (i.e. from the date of initial haematuria referral and the date of additional investigations completed).

Our tertiary outcome is defined as the time taken from the date of haematuria referral and date of treatment of bladder and upper tract malignancies.

Methods

100 consecutive patients were identified from our referral log using the diagnostic code “new haematuria” over the 10 month period (November 2010-July 2011) preceding the introduction of OSHC (group 1). Group 2 consists of the first 100 patients attending the weekly OSHC between August 2011 and April 2012. Exclusion criteria include concurrent urinary tract infection, previous diagnosis of bladder tumours or upper tract malignancy.

Both groups of patients underwent basic investigations consisting of renal tract ultrasound, flexible cystoscopy, urine microscopy, culture and cytology. In group 1 urine cytology was ordered at clinicians’ discretion, whilst in group 2 it was a mandatory requirement reflecting a change in local protocols. Patients considered at high risk of malignancy or identified with abnormal results from basic investigations underwent additional CT IVU in both groups.

Data on the dates and outcomes of patients’ referrals, investigations and treatment were collected retrospectively from referral logs, clinic letters, operation notes and radiology reports available on an electronic health record system.

Conclusions

OSHC has lead to significant improvements in both completion and timeliness of macroscopic haematuria assessment at our unit.

Future studies focusing on whether this can be translated to prompt treatment will be valuable as this study envisages a positive prospect and similar models may provide solutions in delivering streamlined care of patients with macroscopic haematuria.

References

1. Rodgers M. et al, Diagnostic tests and algorithms used in the investigation of haematuria: systematic reviews and economic evaluation. Health Technology Assessment 2006; Vol. 10: Nov 18

2. Blick C. et al, The impact of the two-week wait rule on the diagnosis and management of bladder cancer in a single UK institution. Annals of Royal College of Surgs of England. 92(1):46-50, 2010 Jan.

2. Ooi WL. et al, ‘One stop’ haematuria clinic in Fremantle Hospital, Western Australia: a report of the first 500 patients. BJU International. 108 Suppl 2: 62-6, 2011 Nov.