Implementing and evaluating the efficacy of an acute care urology model of care in a large community hospital

Abstract

Introduction: We implemented an acute care urology (ACU) model at a large Canadian community hospital to determine the impacts on safe and timely care of patients with renal colic. The model includes a dedicated ACU surgeon, a clinic for emergency department (ED) referrals, and additional daytime operating room blocks for urgent cases.
 Methods: We conducted a chart review of 579 patients presenting to the ED with renal colic. Data was collected before (pre-intervention, September to November 2015) and after (postintervention, September to November 2016) implementation of the ACU model. Secondary methods of evaluation included surveying patients and 20 ED physicians to capture subjective feedback.
 Results: Of the 579 patients presenting with renal colic,194 were diagnosed with an obstructing kidney stone and were referred to urology for outpatient care. The ED-to-clinic time was significantly lower for those in the ACU model (p<0.001). Furthermore, the ACU clinic resulted in significantly more patients being referred for outpatient care (p=0.0004). There was also higher likelihood that patients would successfully obtain an appointment post-referral (p=0.0242). The number of after-hours and weekend surgeries decreased significantly after dedicated ACU daytime operating room (OR) blocks were added in Sep 2015 (p<0.0001). All surveyed patients rated the care as either “excellent” or “very good,” and all physicians believed the ACU model has improved patient care.
 Conclusions: The ACU model has shown benefit in ensuring timely followup for ED patients, reducing use of after-hour OR time, and improving patient and physician satisfaction.

A urological urgent assessment unit service evaluation in a United Kingdom hospital

“…Exact numbers and types of patients that could be dealt with by the urology nurse practitioners would be an insightful piece of further research in this area, both in terms of role expansion and further education of UNPs', but also how this may streamline services for patients and relieve on‐call urology registrars and consultants for more complex tasks which was suggested by BAUS 10 . Importantly, this study provides the patients perspective, however, the opinion of the urology specialist nurses', the urology doctors, GPs' and ED staff (of which another study concerning an acute urology service did briefly cover 12 ), especially in regards to the ED staff who found it beneficial may be useful further research. Such a focus would further add to how the UAU works in practice and provide more context around how these units function.…”

“…A small part of this study focussed on patient feedback, with just 11 patients providing ‘voluntary’ feedback over 3 months using a combination of open‐ended and closed‐ended questions. They cite 100% satisfaction with the unit, waiting times were timely and they were given clear information about their care 12 . Although, as this aspect was not a strong focus of this study no further details are provided in terms of any open‐ended response themes, or indeed the questions used.…”

Don’t call it a job market

“…Novel practice phenotypes, including models like acute care urology, roving locum, or surgical/clinical assist roles, would arise bottom-up, driven by the desires of the applicant for less overhead or continuity, and not top-down, offered up as leavings from those able to offload them. 4 What we've got is often the opposite. A large number of us find our practices at the last minute, when an unannounced retirement or move suddenly frees a spot that we sidle into.…”

Acute care for renal colic in Canadian healthcare — a commentary on emergency department patient flow metrics and treatment options

“…[2][3][4][5] In this issue of CUAJ, Kirubarajan et al describe the implementation an acute care urology (ACU) model at a large, communitybased hospital in Toronto, Canada. 6 Briefly, the ACU model described included dedicated ACU daytime operating room (OR) blocks, a dedicated ACU surgeon, and a creation of a rapid referral clinic for emergency department (ED) patient referrals in 2016. Their study focused mainly on evaluating the impact of an ACU model on patient flow metrics, including ED length of stay, time from urology referral to consultation, and number of after-hours surgeries for treatment of renal colic.…”