Modernised Care Pathway significantly reducing wait times for Urology Patients

The introduction of a Modernised Care Pathway for Nurse-Led Urology Clinics at Galway and Portiuncula University Hospitals has significantly reduced waiting times for urology patients awaiting assessment for Lower Urinary Tract Symptoms (LUTS).

The Advanced Nurse Practitioner (ANP) Urology LUTS clinics, which were developed as part of the model of care for urology (RCSI 2019), led by Professor Eamonn Rogers, Consultant Urologist, HSE West and North West were established to improve access to care, reduce waiting lists, with efficient referral to consultant urologists for surgical intervention if required.

Waiting times for patients have reduced dramatically since the ANP LUTS Clinics commenced in 2021. A triweekly clinic at Galway University Hospitals has seen the length of time that patients are waiting, reduced from five years to between 9 and 12 months. In addition, a weekly outreach clinic established at Portiuncula University Hospital to provide patient care as close to home as possible, has a wait time for patients of 6 to 12 weeks. As of the end of September, 7,682 patients had been seen across both clinics since they were set up.

Separately, a ANP LUTS Clinic at Roscommon University Hospital which was established in February of this year, has reduced the length of time that patients are waiting to around 8 to 12 weeks, down from 1 to 2 years.  Between February and September of this year, 280 patients had been seen at the clinic in Roscommon.

The referral pathway to clinics for patients with LUTS is via their GP to a Consultant Urologist who triages the referral to the ANP-LUTS clinic.

Lower Urinary Tract Symptoms and specifically male LUTS is one of the most prevalent complaints presenting to urology outpatients.

The clinics are managed by two Urology Advanced Nurse Practitioners, Geraldine Rooney and Therese Kelly in collaboration with eight Consultant Urologists from Galway University Hospitals.

"The clinics provide comprehensive advanced physical patient assessments with the ability to interpret multiple assessments and interventions to guide a diagnosis and plan delivery of care, which may include direct referral to a Consultant Urologist for surgical intervention,” explains, Therese Kelly, Advanced Nurse Practitioner in Urology at Galway and Portiuncula University Hospitals.

"They represent a move towards a more holistic approach to LUTS care. They ensure that patients are evaluated and treated in a timely manner, that patient outcomes improve while hospital admissions are minimised, and that consultants have more time to see patients with complex urological conditions.”

Geraldine Rooney, Advanced Nurse Practitioner in Urology at Galway University Hospitals said, “An integral part of this nurse-led service is to provide evidence based care, promote healthy lifestyle and educate patients regarding their urological condition.

“Our service recently published a study on ‘Patient reported experiences of consultation with an Advanced Nurse Practitioner in urology’ using the validated Patient Enablement and Satisfaction Survey (PESS) and we were delighted with the very positive feedback from our patients.

One patient reported, “I found the Advanced Nurse Practitioner to be very knowledgeable and professional. Right from the beginning she put me at ease and assured me as well as encouraged me to embrace self-catheterisation. I was very hesitant about this at the start but with patient and understanding approach I soon became relaxed and confident about the process. Overall my experience has been very positive with the Nurse Practitioner.”

“Improving patient quality of life is paramount to our clinics and we look forward to progressing and further enhancing the patients journey in urology,” added Geraldine.  

Professor Eamonn Rogers, Consultant Urologist, HSE West and North West and Co-Lead of the National Clinical Programme for Surgery said, “The Nurse-Led Urology Clinics are one of the three Modernised Care Pathways within the Model of Care in Urology developed by the NCPS to improve access for urological care and to reduce waiting times to be seen in clinics.” 

“Research conducted by the National Clinical Programme in Surgery revealed that male LUTS is one of the more common causes for referral to a urologist within our hospitals across HSE West and North West.

“The introduction of these Nurse-Led Urology Clinics has resulted in a significant reduction in the number of patients waiting to be assessed, as well as the number of patients requiring a consultant review, which demonstrates a quality improvement in service provision and an important step towards integrated management and care delivery,” added Professor Rogers.

Advanced Nurse Practitioners are the highest level of clinical experts in the nursing profession in Ireland today and are transforming services for patients through an expanded scope of practice, greater clinical autonomy and decision-making.