Changes to the urology service at Guy's and St Thomas' foundation trust have eliminated long outpatient waiting lists. New patients are seen within 10 days of referral, while patients with established diseases are seen in disease-specific, nurse-led clinics.

The vision for the service was to develop efficient, effective and safe outpatient care. The aim was to eliminate delays, minimise queuing and bring all the different aspects of urological diagnosis together in one place.

The urology centre has been operating since January and the project was partly funded by a grant from the Guy's and St Thomas' Charity.

The grant also enabled a thorough review of the existing service to enhance efficiency and improve the experience and outcomes for patients. The new one-stop model was tested in pilot clinics. The following results were achieved:

  • 70 per cent of patients received a diagnosis on the day;

  • 50 per cent of patients who received a diagnosis could be reassured and discharged back to the care of their GP;

  • follow-up rates and hospital visits were dramatically reduced.

The ideas for the project were developed by a team led by consultant urologist Tim O'Brien and project manager Elaine Jenkins.

Patient focus

"My vision was to create a truly patient focused service, with minimal queues for appointments, more efficient hospital services and quicker diagnosis," says Mr O'Brien. "The new centre has a far more efficient way of working, which will save time, improve the patient experience and most importantly help save lives."

Key features of the new service include:

  • no waiting list for outpatients;

  • new patients are given appointments within 10 days of referral;

  • up to 120 patients can be seen each week;

  • consultations, ultrasound examination, cystoscopy, flow studies, urodynamics, prostate biopsy, and blood/urine testing are all available on the same day;

  • letters explaining the outcome of the visit are generated for patients before they leave the centre;

  • multidisciplinary disease-specific clinics are in place for prostate cancer,renal/testis cancer, bladder cancer, erectile dysfunction, stone disease, andcontinence;

  • the role of clinical nurse specialists has been expanded to help improve the care of patients with long-term diseases;

  • opportunities for teaching and research have been improved.

Design advantages

The purpose-built centre takes all aspects of patient care into account, including specifically designed changing and toilet facilities and a private booth allowing patients to hand over urine samples discreetly.

The new centre has also led to significant benefits for staff, with communication dramatically improved across the various staff groups. For the first time, the offices and the clinical areas are near each other, which means it is much easier to communicate or call ad-hoc meetings to deal with issues as they arise.

The transformation of the centre has also had a positive impact on staff morale. Feedback from clinical staff has been that they all enjoy working in the new way. Radiologists and sonographers particularly appreciate the opportunity to interact and discuss cases (with the patient present) with the surgeons, which is multi-disciplinary working at its best.

Salma Hasnain, lead superintendent sonographer at the trust, said: "The promotion of an excellent multidisciplinary approach for all professionals allows good communication between the different staff groups in patient diagnosis. The sonographers enjoy working in the centre as it facilitates a more focused teaching environment and the opportunity to be involved in research and development."

New roles have also been created. Clinical nurse specialists now have enhanced roles around the management of patients with established disease and in undertaking investigations, prostate biopsies and flexiscopes.

The role of clinic co-ordinator has also been created. This administrator oversees the patient referral pathway from receipt of referral letter until the patient is discharged from the one-stop clinic. The clinic co-ordinator liaises with patients, GPs and consultants to ensure relevant tests and paperwork are completed before the patient attends.