Audit of Urology cases in ACU Audit - 2318

1. Clinical Audit Report Audit of Urology cases in ACUAudit - 2318 Urology Dept / Surgery Division Dr C Cordell, FY1 Dr A Bancu, Audit Project Lead Mr C Dawson, Clinical Lead Audit meeting 27/02/19

2. Audit team

3. Background • Rationale: • To make a baseline assessment of the Urology department’s use of the ACU(Ambulatory Care Unit) • Clinical background: • Patients are reviewed in ACU by the on call team • Various reasons to presentation including the renal colic pathway • The on call team consists of: • One FY1/FY2/SHO • One Middle grade

4. Background • Local background: • Relieve pressure from ED • Ensure faster turn around time for non-emergent patients • Fewer clinic appointments reducing waiting times • Helps to relieve pressure on busy radiology departments • Middle grades can act upon CT-reports prior to official reporting

5. Project’s aims and objectives • Project background: • Audit of Urology’s use of ACU • Trust wide push to utilise ACU for reviewing patients • ACU is the perfect format for reviewing many of our non-emergent patients via the trust’s pre-defined pathways • To ensure we are referring suitable patients and that they are reviewed in a timely manner • Objective: • To monitor patient wait times, with a target of less than 4 hours and that appropriate patients are reviewed within ACU

6. Audit standard(s)

7. Methodology • Sample data • All urology patients that were asked to attend ACU for review • Data was collected from a 3 month period (01/10/18-31/12/18 inc.) • All Urology patients that attended were included • Data collection • Scope of the project • All Urology patients that are reviewed within the ACU department at Peterborough City Hospital. • Timescale • Presentation is the end of this cycle • Action plan to be implemented from the recommendations of this audit • For re-audit in 1 year to monitor compliance • Method used in collecting the data • A Retrospective study of ACU attendance over an 3 month period. • The information is taken from IT system data and Electronic Health Records

8. Reason for Attendance

9. Day of Attendance

10. Referring party

11. Admissions from ACU

12. Errors with data

13. Timing Attendance

14. Project outcome

15. Discussion • It became apparent during this audit that the target is somewhat “set up to fail”. Patients attending for CT KUB slots in ACU are offered appointments at 08:15, 08:30, and 08:45 • Whilst this is convenient for the Radiology Department is conflicts with the Consultant led Ward round

16. Recommendations • The Audit was discussed at the Clinical Governance Half Day on 27th Feb 29. One of the chief recommendations (communicated to all staff on the day and with immediate effect) is that the CT scans should be reviewed as part of the Consultant Ward Round briefing session,at 09:00 • This would allow one of the Middle grades to attend ACU and take appropriate action with these patients, discharging them well before their breach time • A further recommendation (with immediate effect) is that Middle grades should not wait for the report of the CT KUB, as this will inevitably result in the patient pathway breaching

17. Recommendations • The Audit also uncovered difficulties with ACU timings. There is no defined method of “stopping the clock” for the patient pathway • There needs to be a definitive timing structure and clear outline for when the clock starts and when it stops • The Audit panel recommended that weuse the patient’s initial arrival time (pre-assessment) as the start of the pathway and the clock ends when the junior doctor that has reviewed the patient adds a note on E-track (currently ACU uses a paper based system)

18. Actions to be taken