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Meet the team

Also:

  • Prof David Walker, intensive care consultant
  • Dr Daron Smith, urology consultant
  • Dr Bruce McRae, microbiology consultant
  • Urology CNS

What is the challenge your project is going to address and how does it connect to your chosen theme?

The routine testing of urine prior to urological surgery in the pursuit of sterile urine has become standard practice nationally. As a consequence, a large number of patients undergo needless repeated cycles of antibiotic therapy and repeated out-patient visits for urine re-testing in the days and weeks prior to surgery, exposing each to the recognised risks and stretching a limited outpatient resource beyond its current capacity.

Add to this the risk of antibiotic drug reaction, the breading of highly-resistant bacterial strains through antibiotic overuse and the inconvenience to our patients, who often travel the length of the country to attend repeated appointments. Evidence supports a more pragmatic approach to antibiotic use for what in most patients is an innocent bacterial colonisation termed asymptomatic bacteriuria. This QI project will bring evidence-based change to an outdated pathway, support clinicians on the journey and objectively assess the impact of our intervention.

What does your project aim to achieve?

The project aims to develop a new clinical pathway for the management of preoperative asymptomatic bacteriuria, based on evidence from the Urinary Tract Infection (UTI) guidance in use by NICE and PHE (European Association of Urology https://uroweb.org/guideline/urological-infections/) for asymptomatic bacteriuria in adults including prior to urological surgery and other available evidence.

It aims to improve patient experience and outcomes as well as hospital costs and staff experience by

  • Reducing on the day surgery cancellation.
  • Reducing unnecessary hospital appointments and related travel.

The project will address the important public health aspects of infection control and antimicrobial stewardship by reducing unnecessary antimicrobial treatment that may lead to resistance.

There will be advantages from an environmental point of view by reducing unnecessary CO2 emissions thanks to reduced travelling.

How will the project be delivered?

Using Quality Improvement methodology, deliver a co-produced (with UCLH urology patient associations and patient engagement groups), multidisciplinary (urology, perioperative medicine, anaesthesia – consultants, clinical nurse specialists, managers, health economist and statistician) project, which delivers change process and monitors all aspects of patient safety.

  1. Project administration – will provide the overall framework for delivery of a successful project.
  2. Development of patient-reported outcome/experience measures and testing.
  3. Design and incept this facilitatory pathway of care, to support non-hospital-based patient management and eliminate the requirement of multiple patient hospital attendances.
  4. Assess the impact of this study based on improved operational efficiency, patient and clinician experience and formal cost effectiveness analysis.

Engaging patients, staff, partners and Q members will be important throughout the design process.

What and how is your project going to share learning throughout?

The learning from this project has potential benefits for all NHS Trusts and other healthcare facilities that offer urology surgery services.In developing a robust evidence-based pathway we will consolidate expertise and unique project insights that can be shared.

Progress and learning will be shared progressively by our team share the learning via all channels offered by the Q Community as well as presentations and publication at local, regional and national level and via innovative communication tools such as social media posts, blogs, videos and learning events.

How you can contribute

  • Networking and links to other similar initiatives.
  • Ongoing discussion, exchange, feedback and support.
  • Help from the Q community to answer and solve any critical questions and challenges.
  • Signpost resources that might be available to teams eg toolkits, guides.

Plan timeline

5 Jan 2020 Stakeholder engagement, including patient consultation
3 Feb 2020 Mapping of resources and health economic potential
17 Feb 2020 Agreement on a pilot
2 Mar 2020 Start of pilot
6 Apr 2020 PDSA1
4 May 2020 PDSA1
1 Jun 2020 PDSA3
5 Jul 2020 Project evaluation, including Health economic data analysis
7 Sep 2020 Project dissemination

Comments

  1. A fantastic idea especially when a positive urine analysis on the day of surgery as well as untreated asymptomatic positive urine culture (MSU sent at pre-assessment) are the commonest avoidable reasons for "on the day cancellation".

  2. Guest

    Laura Sarmiento Valero 1 year, 6 months ago

    It is a great initiative and it has potential to make a difference to patients (reducing unnecessary treatments and surgical cancellations) , pre-assessment staff (workload) and hopefully long term it will also have an impact reducing antimicrobial pressure and therefore the presence of resistant bacteria. Great Work!

  3. Guest

    Catherine Pengelly 1 year, 6 months ago

    The nursing team in Urology Pre-assessment are really behind this project - it's already made a big difference to how we work. Fascinating to see something so useful coming to life.

    1. Thank you Catherine, and it's amazing to have such engagement from the whole perioperative team: the patient benefits are evident and also the potential rationalisation of care, improving efficiency and savings. Touching at all points in the IHI Triple Aim.

  4. Guest

    Viki Mitchell 1 year, 6 months ago

    Good to see  a focus on rationalising pathways for patients, especially since pre-op antibiotics change the microbiome and may actually do more harm than good.

    1. Thank you for your support Viki,

      we really hope to have a big impact with this project, extending beyond the urology surgery.

  5. Guest

    James Holding 1 year, 6 months ago

    Great idea for a project - such an important clinical conundrum - and we are currently wasting clinician and patient time, reinventing wheels, probably for no reason.

    Well done all

    1. Thank you James,

      Despite the fact that this project is currently focusing on urology patient it can be even more impactful when extended to other specialties, changing the paradigm! Thank you for your support!

  6. Guest

    David Walker 1 year, 6 months ago

    The opportunity to bid for QI funding is very exciting for our MDT group. This project began with a real clinical issue of magnitude, which has patient safety and experience at it's heart.  Our MDT have poured so much energy into understanding the problem and the context surrounding the need for change. Our QI intervention evolves from a robust analysis of the available evidence base and will further benefit from a mixed methods analysis of the data, involving a number of experts from a number of clinical/scientific backgrounds. The proposed work has already received the backing of our medical director, trust clinical guideline and policy committee and the unanimous support of the surgical consultant body.

    We are also pleased to hear from both Elizabeth and Thomas in this blog and would be delighted to hear more about their work in due course.

    We continue to consult, plan and refine our idea ahead of undertaking this work in 2020.

    Thanks everyone for comments.

    David

  7. I could help by illustrating pathways and defining processes if this is required. I think it would be worth giving the methodology that I have developed a try for this project. It's a good development/improvement tool.

  8. Of course this gets my support, as while many Trusts have implemented solutions to this issue there is no robust evidenced improvement approach to share for rapid adoption. Hoping this team will provide this evidence and toolkit.

  9. I think this is a great idea and is something our Urology department had looked at. Have you seen the iPhone app for urine testing? We'd considered posting out to patients the week before their scheduled operation so that they could test their own urine and we could detect potential UTIs in advance. I know it's being used in some renal units for transplant patients.

    1. Hi. Sorry for the delay in replying (leave). The one we looked at was by a firm called 'health.io'. I'm not sure if the urology team actually started to use it. Salford renal unit were, I think.

    2. Thank you for you comment! This is really interesting- on a quick browse, I have seen that there are a couple of apps available. Do you use any in particular?

  10. Dear Emilie,

    great idea 😊. Do you connect at all with fellow Q, Elizabeth Beech? She is an inspiring advocate for better use of antibiotics and medicines management in general. I would reach out to her on Twitter @elizbeech if I were you to see if she had any good ideas or contacts for you. If you do, say hello from me 😊

    Take care

    best wishes

    Anna

    1. Thank you Anna for your suggestion,

      It was very useful to connect with Elizabeth and discover the huge amount of work done in a similar field.

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