National Re-Audit of Urology Outpatient Practice in UK

Abstract

Introduction: In 2002 a National structure audit was conducted to assess UK urologists' compliance with BAUS guidelines on outpatient provision. Given the recent change in government emphasis on waiting targets, and the possible impact of MMC and EWTD on trainees, we re-audited the contemporary urological clinic-based workload and service provision. Methods: All 649 UK consultant urologists were asked to complete a postal questionnaire. This provided outpatient clinic information on medical staff, clinic frequency, numbers of new and follow-up patients seen, and geographical region. Data was compared to 2002. Results: Usable questionnaire return rate was 65%. Median clinics/week were 1.87 (1-5) seeing a mean of 11.2 (1-32) new and 21.5 (1-80) follow-ups. Since 2002 consultant appointments have increased by 20%, SpR clinic attendance has decreased by 10%, with 'consultant-only' clinics increasing from 15% to 20.7%. Compliance with BAUS standards remains very low (18% vs. 21% ( 2002)) with the average consultant team 'over-performing' by a factor of 1.4. There were wide inter-and intra-regional variations. Conclusion: Despite growth in consultant numbers since 2002, very few urological teams are able to meet the BAUS clinic guidelines. A trend has been demonstrated in clinic towards a consultant-led service with less support from doctors-in-training.

The impact of a computerized care records service (CRS) on doctors’ work patterns in urological outpatient clinics

“…Before April 2008, a senior urologist in our hospital would see 20 patients in a typical clinic. As outlined above, this was in line with a national average of "overperformance" of a factor 1.4 [4] as compared to guidelines. This corresponds to 12 minutes consultation time per patient which at that time was a mixture of conversation, viewing referral letters and results, and dictation.…”

“…Because of the latter, times were deemed appropriate although an average of 12 minutes per patient could be challenging depending on the patient population. Therefore, BAUS issued its guidelines recommending no more than 15 patients per doctor per clinic [3,4] in 2003.…”

“…During August 2008, medical students shadowed three senior urologists during outpatient clinics on a one-to-one basis. New referrals and follow-up patients were booked and seen at a ratio of 1:2 which corresponds to national standards [3,4]. Consultations were broken up and separately measured in seconds for: 1) pre-consultation computer and notes research during which the patient was kept in the waiting area (referral letters and previous correspondence from different departments for new patients, previously requested results for follow-up patients, and in case of patients suffering from urinary stone disease also booking time for an X-ray on arrival), 2) the actual consultation with the patient during which no forms or computerized requests were filled in or processed, 3) post-consultation computer and written administration (computerized bookings of investigations, admission forms etc.…”

“…More recently, government initiatives to improve patient care and reduce waiting times have added even more pressures on the effective use of outpatient resources [2]. Indeed, only around 20% of urologists are able to follow recommendations of the British Association of Urological Surgeons (BAUS) for outpatient workload "A Quality Urological Service for Patients in the new Millenium" published in 2000 [3,4]. The average urology consultant team in the United Kingdom (UK) "overperfoms" in outpatient clinics by a factor of 1.4 [4].…”

“…Indeed, only around 20% of urologists are able to follow recommendations of the British Association of Urological Surgeons (BAUS) for outpatient workload "A Quality Urological Service for Patients in the new Millenium" published in 2000 [3,4]. The average urology consultant team in the United Kingdom (UK) "overperfoms" in outpatient clinics by a factor of 1.4 [4]. Consultants do spend more time with patients than in the past.…”