Implementation of a nurse-led lower urinary tract symptoms (LUTS) clinic reduces general urology clinic workload in a Mo
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ORIGINAL ARTICLE
Implementation of a nurse-led lower urinary tract symptoms (LUTS) clinic reduces general urology clinic workload in a Model 4 Hospital: a pilot study in Tallaght University Hospital Kevin G. Keane 1 & Mohammud Shakeel Inder 1 & Caroline McIntyre 1 & Shawgi Omer 1 & Elizabeth McEvoy 1 & Lisa G. Smyth 1 & Rowan G. Casey 1 & Arun Z. Thomas 1,2 & Rustom P. Manecksha 1,2 & Robert J. Flynn 1,2 Received: 5 September 2020 / Accepted: 30 October 2020 # Royal Academy of Medicine in Ireland 2020
Abstract Background With among the lowest urologist per population ratios in Europe, the demand for urology specialist review in Ireland far exceeds supply. Lower urinary tract symptoms (LUTS) account for a significant number of referrals. The traditional paradigm of every patient being reviewed in a consultant-led clinic is unsustainable. New models of care with nurse-led clinics represent an opportunity to optimise limited resources. Methods Existing long-waiting male LUTS referrals were triaged to a specialist nurse-led LUTS clinic. After urology CNS assessment, charts were reviewed by a consultant urologist and a plan formulated. Relevant data were prospectively collected and analysed. Results Fifty-eight new male patients with LUTS were seen over a 6-month period with an average waiting time of 15.8 months. Patients were assessed with uroflowmetry, IPSS and DRE. Mean age was 64, IPSS 14.5, Qmax 18.3 ml/s and PVR 89 ml. Thirty patients (52%) were discharged directly with lifestyle modification and medical therapy. Twenty-eight patients (48%) required one or more further investigations and subsequent review; 11 had flexible cystoscopy, 4 had urodynamics, 5 had prostate MRI, and 2 patients were listed for surgery (TURP and circumcision). The remaining 10 patients were for review post trial of lifestyle modifications and/or medical treatment. After review/investigations, 4 more patients were discharged. A total of 32 patients (55%) were discharged or listed for surgery after initial assessment. This total increased to 62% after a second review/investigations. Conclusion Introduction of a CNS-led LUTS clinic has significantly reduced the number of patients requiring follow-up in general urology clinics, representing a quality improvement in service provision. Keywords Clinic . LUTS . Nurse-led . Urology
Introduction Lower urinary tract symptoms (LUTS) is the term used to describe the constellation of symptoms experienced by patients relating to the bladder, prostate and urethra. LUTS account for a substantial number of referrals to the urology
* Kevin G. Keane [email protected] 1
Department of Urology, Tallaght University Hospital, Dublin, Ireland
2
Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
outpatient service and can be a cause of considerable distress to patients, effecting their physical, mental and social health [1]. Urology is a surgical speciality with the potential to significantly improve the quality of life of patients, often with minimal intervention. C
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