Meet the team
Emilie Martinoni Hoogenboom
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- 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 This QI project will bring evidence-based change to an outdated pathway, support clinicians on the journey and objectively assess the impact of our intervention.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.
- Project administration – will provide the overall framework for delivery of a successful project.
- Development of patient-reported outcome/experience measures and testing.
- Design and incept this facilitatory pathway of care, to support non-hospital-based patient management and eliminate the requirement of multiple patient hospital attendances.
- 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.
|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|