Transformation of urology outpatients Imperial College Healthcare NHS Trust

The Imperial College Healthcare NHS Trust team implemented an improved care pathway to support short-notice access to urology outpatient services for new patients. By introducing daily clinics of up to eight patients, the team maintained the same weekly patient capacity but spread it throughout the week. 

Each clinic offered a 'one stop' service, with diagnostics and clinical consultation undertaken on a single visit. Nurses were responsible for arranging blood tests, imaging and cystoscopies, with all test results ready in time for the patient to see the consultant.

Who was involved

The programme was led by consultants and involved multidisciplinary working across the urology department and other teams within the hospital, such as radiology and pathology.

Outcomes

The new to follow up ratio for the Urology service was reduced from 2.7 to 1.6 over a period of eight months and this improvement has been sustained. The number of patient visits from referral to diagnosis fell by at least 50%. Patients were able to take less time off work for appointments, while the rapid turnaround of diagnostic tests minimised the ‘uncertainty’ time which often causes unnecessary anxiety for patients and their families.

The new clinic model made better use of consultants' time and reinforced the nursing team's critical involvement in the service.

Challenges

At the start of the programme, nursing was delivered by a small number of employed staff with a significant number of posts filled by temporary bank staff. The lack of stability in the nursing team along with limited full time nursing supervision created challenges with communication and delivering a consistent service.