Does the merger of a District General Hospital with a Tertiary Urology Centre shorten treatment times for acute stone disease? A quality improvement project.
BAUS ePoster online library. Kiruparan N. Jun 25, 2019; 265252; CU-1
Nanthesh Kiruparan
Nanthesh Kiruparan
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Abstract
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Introduction: A multidisciplinary team approach is required in order to provide safe and prompt care to patients. The recently published Getting it Right First Time (GIRFT) Urology guidelines aim to improve the secondary care pathway for patients with urinary tract stones. The aim of this quality improvement project was to ascertain whether time to treatment of stones could be reduced by merging the acute stone service of a District general hospital with a tertiary urology centre in November 2017.
Methods: PDSA cycles were undertaken before and after the merger of hospital services, the first between April-June 2017 and the second between April-June 2018. We reviewed all CT urinary tract scan results undertaken at a single centre and only included acute presentations of renal/ureteric colic in our study (n=161 in 2017, n=194 in 2018).
Results: Mean length of treatment following the merger in November 2017 was reduced from 90.08 days to 61.55 days. After the merger fewer patients required surgical intervention and readmission rates due to stone disease remained equivocal.
Conclusions: On average there was a 28.5 day reduction in time to treatment after the merger. In terms of patient factors this is a significant improvement. This shows that the centralisation of acute treatment of stone disease reduces time to treatment and has no demonstrable adverse effect on patient outcome.
Introduction
A multidisciplinary team approach is required in order to provide safe and prompt care to patients. This has been adopted by many medical specialties and the use of this in urology is not just simply limited to cancer management. The recent Getting it Right First Time (GIRFT) Urology guidelines aim to improve the secondary care pathway for patients with urinary tract stones(Harrison, 2018).
Two hospitals within the East Midlands merged their acute urology services in November 2017. King's Mill Hospital (KMH), Mansfield and Nottingham City Hospital. Prior to the m
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