A novel method for eliminating missed follow up: 'The urology histology clinic program'

Abstract

Introduction and Objectives: The timely and accurate follow up of intra-operative specimens remains a challenge in surgical departments especially in public healthcare where staff turnover is high. Missed or delayed follow up risks significant morbidity and even mortality. Here we describe the set-up of a robust system, the “urology histology clinic” (UHC), to follow up pathological specimens collected in a busy urology department. Methods: A weekly consultant only clinic with a cap of 10 (±2) patients was set up where all patients who had surgical specimens collected were followed up within a two week period of their procedure. The consultant conducting the clinic rotated weekly and patients were reviewed by the consultant of the week irrespective of who the primary surgeon was. To generate referrals to the UHC an application 'e-blue slips' was created and compulsorily filled out by surgeons every time a specimen was collected. To co-ordinate both the clinic and referrals as well as to cross check all specimens, a dedicated clinical nurse coordinator (CNC) with significant urological experience was allocated 24 h per week to UHC program. His job included but was not limited to scheduling UHC appointments from referrals, cross checking theatre data to ensure all patients received referrals and ensuring pathology results were finalized prior to appointments. Results: Over twelve months, 667 patient specimens were referred to the UHC. The majority of specimens were prostate biopsies followed by bladder biopsies. Of all specimens collected intra-operatively only 9.2% of specimens were not referred to the UHC by the collecting surgeon. There were two distinct spikes of missed referrals in September and November. These periods correlated directly with a change in regular staff in the department. After the above process was undertaken and missed referrals were booked into the UHC, we had no patients with specimens collected requiring follow up who were not booked into the UHC. Conclusions: We have demonstrated the set up of a novel follow up system which has eliminated missed follow up of surgical specimens. Additionally, our UHC program allows easy audit of department activity and follow up of surgical patients. A few drawbacks such as extra appointments and surgeons following up patients they did not operate on were noted however, due to the effectiveness of this system it remains in place in our department. We anticipate that with minor changes this system that can be widely adopted to improve patient outcomes.L617745626 <br />