Preliminary assessment of patient and physician satisfaction with the use of teleconsultation in urology during the COVID-19 pandemic.

PURPOSE: Lockdown during the COVID-19 pandemic compelled urologists to change access to healthcare, especially for oncology patients. Teleconsultation is a safe way to receive medical advice without a risk of infection, and was implemented urgently in our academic centres. Our purpose was to evaluate patient and physician satisfaction with teleconsultation set up during the COVID-19 pandemic. METHODS: From March 16th 2020, all face-to-face consultations were cancelled in France, except for emergencies. Teleconsultation was started immediately by five senior urologists in two academic hospitals. All patients received an email survey including the validated Teleconsultation Satisfaction Questionnaire (TSQ) and demographic questions. Data were collected prospectively. Physicians also responded to the TSQ. Patient satisfaction was measured objectively with the validated 14-item TSQ. Each item was scored on a 5-point Likert scale. Factors associated with positive satisfaction with teleconsultation were assessed by multivariable logistic regression. RESULTS: Overall, 105 patients replied to the survey (91.3%). Median age was 66 years (IQR: 55‒71) and 95 were men (90.5%). Median overall TSQ score was 67 (IQR: 60‒69); teleconsultation was judged to be a good experience by 88 patients (83.8%) and four physicians (80%). Patients who met their surgeon for the first time were more likely to have a good experience (OR = 1.2 [95% CI 1.1‒1.5], p = 0.03). CONCLUSION: Introduced rapidly during the COVID-19 lockdown, urology teleconsultation attained a high level of satisfaction among both patients and physicians. A major change in telemedicine use is foreseen in the post COVID-19 era.

Urological service provision during the COVID-19 period: the experience from an Irish tertiary centre.

PURPOSE: Urological service provision has changed dramatically with the advent of the SARS-CoV-2, necessitating restructuring and reorganization. The aim of this study was to review the reorganization of our unit, map the change in volume of departmental activities and discuss potential solutions. METHODS: Departmental activities over the months of April and May 2020 and 2019 were analysed. Details of admissions, operations, diagnostic procedures, outpatient reviews, morbidities and mortalities were recorded. Operations were performed on two sites, with elective operation transferred to an offsite, COVID-free hospital. RESULTS: Seventy-four emergency operations were performed onsite, with 85 elective operations outsourced. A total of 159 operations were performed, compared with 280 in the same period in 2019. Five (5.0%) of 101 admitted patients to the COVID hospital contracted COVID-19. No patients outsourced to the COVID-free hospital were infected there. Outpatient referrals to urology service decreased from 928 to 481. There was a 66% decrease in new cancer diagnoses. A virtual review clinic was established, with remaining outpatients reviewed through a telephone clinic platform. CONCLUSION: Compared with 2019, we performed fewer operations and outpatient procedures, had fewer admissions and diagnosed fewer patients with new cancers. However, outsourcing elective operation to designated non-COVID hospitals prevented the infection of any patient with COVID-19 in the post-operative period. The use of virtual clinic and telephone clinic has had some success in replacing traditional outpatient visits. The overall significant decrease in operative volume will likely precipitate a mismatch between demand and service provision in the coming months, unless capacity is increased.

Advanced Chronic Kidney Disease Units in Spain: a national survey on standards of structure, resources, results and patient safety. / Unidades de Enfermedad Renal Crónica Avanzada en España: una encuesta nacional sobre los estándares de estructura, recursos, resultados y seguridad del paciente.

BACKGROUND AND OBJECTIVE: Recently, the Advanced Chronic Kidney Disease Units (UERCA, in Spanish) have been developed in Spain to offer a better quality of life to patients with advanced chronic kidney disease (ACKD), improving their survival and reducing morbidity in this phase of the disease. Nowadays, there is not much evidence in the Spanish and international literature regarding the structure and how to achieve these objectives in the UERCA. From the ERCA working group of the Spanish Society of Nephrology (SEN), this project is promoted to improve care for ERCA patients through the definition of quality standards for the operation of the UERCA. MATERIAL AND METHODS: An initial proposal for quality standards concerning the operation of the UERCA was configured through consultation with the main sources of references and the advice of an expert working group through face-to-face and telematic meetings. Base on this initial proposal of standards, a survey was conducted and sent it via email to 121 nephrology specialist and nursing professionals with experience in Spanish UERCA to find out, among others, the suitability of each standards, that is, its mandatory nature or recommendation as standards. The access to the survey was allowed between July 16th, 2018, until September 26th, 2018. RESULTS: A total of 95 (78.5%) professionals participated out of the 121 who were invited to participate. Of these, 80 of the participants were nephrology specialists and 15 nursing professionals, obtaining a varied representation of professionals from the Spanish geography. After analyzing the opinions of these participants, the standards were defined to a total of 68, 37 of them (54.4%) mandatory and 31 of them (45.5%) recommended. Besides, it was observed that the volume of patients attended in the UERCA is usually above 100 patients, and the referral criteria is generally below 25-29 mL/min/1.73 m2 of glomerular filtration. CONCLUSIONS: This work constitutes a first proposal of quality standards for the operation of UERCA in Spain. The definition of these standards has made it possible to establish the bases for the standardization of the organization of UERCA, and to subsequently work on the configuration of a standards manual for the accreditation of ERCA Units.

Delivery of urological services (telemedicine and urgent surgery) during COVID-19 lockdown: experience and lessons learnt from a university hospital in United Kingdom.

BACKGROUND AND AIMS: Our departmental planning for COVID-19 was actioned a week before the lockdown (13th March 2020). We look at a 7- week lockdown activity for all scheduled outpatient clinics and urgent procedures. METHODS AND RESULTS: A total of 2361 outpatient clinic slots (52.6% oncology slots and 47.4% benign urology slots) were scheduled during this period. The oncology slots included 330 (26.5%) flexible cystoscopy, 555 (44.7%) prostate cancer and 357(28.8%) non-prostate cancer slots. The benign urology slots included 323 (28.8%) andrology, 193 (17.2%) stones and 603 (54%) lower urinary tract symptoms (LUTS) slots. Of the total oncology outpatient slots (n = 1242), 66.3% were virtual consultations, 20% were face-to-face and 13.6% were cancelled. Of the total benign outpatient slots (n = 1119), 81% were virtual consultations, 9.7% were face-to-face and 9.3% were cancelled. A total of 116 anaesthetic surgical procedures were carried out, of which 54 (46.5%) were oncological procedures, 18 (15.5%) were benign urological procedures, and 44 (38%) were diagnostic procedures. CONCLUSIONS: Hospitals and urologists can benefit from the model used by our hospital to mitigate the impact and prioritise patients most in need of urgent care. Reorganisation and flexibility of healthcare delivery is paramount in these troubled times and will allow clinical activity without compromising patient safety.

[COVID-19 Pandemic: Impact and rapid reaction of Urology]. / Pandemia COVID-19: impacto y reacción rápida de la Urología.

The COVID-19 pandemic caused by the SARS-CoV-2 virus has caused tens of thousands of deaths in Spain and has managed to breakdown the healthcare system hospitals in the Community of Madrid, largely due to its tendency to cause severe pneumonia, requiring ventilatory support. This fact has caused our center to collapse, with 130% of its beds occupied by COVID-19 patients, thus causing the absolute cessation of activity of the urology service, the practical disappearance of resident training programs, and the incorporation of a good part of the urology staff into the group of medical personnel attending these patients. In order to recover from this extraordinary level of suspended activity, we will be obliged to prioritize pathologies based on purely clinical criteria, for which tables including the relevance of each pathology within each area of urology are being proposed. Technology tools such as online training courses or surgical simulators may be convenient for the necessary reestablishment of resident education.

[Climate-smart and effective health care reduces green-house gas emissions]. / Klimatsmart och effektiv sjukvård minskar utsläppen av växthusgaser.

Health care is associated with a considerable climate impact and this short review describes approaches to reduce this impact. Reviews from WHO and World Bank Group end up with recommendations on low-carbon and resilient health care which is beneficial for health, economy and climate. The concept of climate-smart healthcare has been suggested as new way of describing this much needed work. In Skåne Region, Sweden a four-step method has been developed to reduce the climate impact of hospital care: to map and identify areas of greatest impact, to work with measures to reduce impact and evaluate the results. A test of this method showed a significant reduction in emission of CO2. In another project, fast-track access for patients with hematuria for diagnosis of bladder cancer showed that the median time from referral to diagnosis was reduced in comparison with conventional care with less costs and less use of resources associated with climate impact.

Elimination of immediate-use steam sterilization of radioactive seed implants.

Immediate-use steam sterilization (IUSS) was routinely used to prepare radioactive seeds for use in elective urology cases at an urban academic medical center. In an attempt to eliminate this practice, the senior clinical nurse queried educators from nearby facilities about their practices for processing these implants and met with all stakeholders to identify concerns and explore acceptable alternatives. After rejecting the alternative of having central sterile processing personnel sterilize the seeds, a project team conducted a trial by using manufacturer presterilized seeds. After the trial and subsequent evaluation, the team decided to convert to using presterilized seeds for all procedures. The incidence of immediate-use steam sterilization for nonemergent brachytherapy procedures was reduced from an average of three per month to zero.

Urology in Stettin (Szczecin). The impact of political changes on progress in urology and medicine.

The history of modern hospitals in Stettin is about 280 years long. The history of urology in Stettin (Szczecin), like in Europe, is closely associated with the construction of the useful cystoscope, discovery of X-rays, and progress in radiology and endoscopy. In Stettin, like in many other cities, patients with urological diseases were treated at departments of surgery or departments of internal medicine. On March 1It, 1919, a specialized urology ward with 27 beds was opened in the Municipal Hospital in Stettin. Dr. Felix Hagen from Berlin was the first head of this ward. The main duty of the urology ward at that time was to conduct differential diagnosis and to offer conservative treatment to patients not needing surgery. Cystoscopy, chromocystoscopy, and radiographs were done in the beginning. Later on, retroperitoneal pneumography, pneumopyelography, and retrograde pyelography were added. Urography in the final period enabled a more precise assessment of the kidney prior to surgery. The preparation of patients with benign prostate hyperplasia for surgery was an important element. Therapeutic activities of the urology ward included transurethral procedures such as lithotripsy of bladder stones and treatment of bladder cancer. Urological surgery was done at the surgery ward. Patients with tuberculosis were usually referred to the Tuberculosis Hospital in Hohenkrug (Zdunowo). In 1935, the urology ward in Stettin was closed and incorporated into the surgery ward. During the World War II, just as during the World War I, the Municipal Hospital in Stettin was transformed into a field hospital. The end of the World War II created a new political situation in Europe. Stettin (Szczecin) and West Pomerania became part of Poland. In 1948, the Polish government established the Pomeranian Medical Academy (PAM) in Stettin. During the first 10 years of its existence all urological operations were performed at surgery wards. In August 1955, a 30-bed urology ward affiliated with the Second Department of Surgery was opened in the district of Pomorzany. The head of the new ward was Dr. Alfons Wojewski (1912-1992), surgeon and urologist from Gdansk (Danzig). In 1962, the ward was transformed into a separate Department of Urology with 62 beds. Prof. Wojewski organized the Department from its foundations, leading it quickly to the level of modern departments in the area of research, teaching, and therapy. After the retirement of Prof. Wojewski, the acting head of the department was Dr. Stanislaw Krason until his death in 1986. He was followed for almost one year by Dr. Stanislawa Spoz. Since May 1987, the head of the Department is Prof. Andrzej Sikorski from Lódz.

Empowering advanced practitioners to set up nurse led clinics for improved outpatient care.

Nurse led clinics have been shown to provide more efficient outpatient care and reduce waiting times. A hospital urology department set up two clinics to improve the patient care pathway, one of which is led by advanced nurse practitioners. This article describes the training and development audit results and plans.

[The 20th anniversary of Urological Center of Main Military Clinical Hospital named after N. N. Burdenko].

In 1988, for the first time according to Directive of Central Command of Armed Forces of USSR in Main Military Clinical Hospital by Burdenko N.N. was founded a interhospital unit - Urological center. The article presents the analyze of work of the Center during 20 years. The most frequent diseases--adenoma of prostate, malignant swelling and benign tumour of urological organs, urolithiasis, traumatic damages of urological organs. During a year 4500-4700 persons are treated, 1450-1500 are operated. Every year 44-77 military medical men are studying, 20-26 clinical attending physicians study for 2 or 3 years. During last 8 years 422 military medical men and 68 clinical attending physicians have studied.

The central urology multidisciplinary team - is it time to change the referral criteria? An audit of practice in a district general hospital in London.

INTRODUCTION: All cancer patients are discussed in multidisciplinary team meetings (MDTs). Certain patients are referred to the Central MDT based on specific national criteria. We wanted to see whether the Central MDT aided in the decision-making process above that of the Local MDT alone. PATIENTS AND METHODS: All MDT forms (local and central) for 2007 were retrospectively reviewed. RESULTS: A total of 217 patients were reviewed at the Local MDT. Of these 217 cases, 102 (47.0%) cases were referred to the Central MDT and 15 of the 102 (14.7%) cases were awaiting investigations at the time of the Local MDT and were, therefore, excluded. For the prostate cancer cases (n = 67), the Central MDT did not change outright the Local MDT decision in any case, but in 6 of 67 (9.0%), advised/excluded patients from clinical trials. For bladder cancer cases (n = 19), 4 of 19 (21.0%) patients had their management changed by the Central MDT. The one kidney cancer case had its Local MDT decision changed by the Central MDT. CONCLUSIONS: This audit suggests that the Central MDT plays a useful role in the decision-making process for bladder and kidney cancers, and helps determine eligibility for clinical trials in metastatic prostate cancer patients. Its value over the Local MDT alone in the decision-making process for non-metastatic prostate cancer is questionable.

Assessing the feasibility of a one-stop approach to diagnosis for urological patients.

INTRODUCTION: Conventional publicly funded out-patient services in many specialties are characterised by delays, fragmented diagnostic processes, and overloaded clinics. This is bad for patients as it is clinically dangerous; bad for managers who spend hours managing the failure; bad for doctors who respond by overloading clinics; and bad for purchasers who have to fund the multiple out-patient visits needed. Sound clinical and financial reasons exist for introducing more efficient diagnostic processes. PATIENTS AND METHODS: A total of 330 consecutive patients referred to the urology department of Guy's and St Thomas' NHS Foundation Trust were invited to attend one of nine one-stop clinics staffed by consultant urologists with specialist registrars, nurses, and clerical staff. Pre-clinic blood and urine tests were ordered based on the referral letter. Clinics had facilities to perform cystoscopy, ultrasound, and urinary flow studies. Correspondence was generated in real time, and a copy given to the patient. RESULTS: Overall, 257 patients attended the clinics. Twenty-three patients cancelled appointments and 50 patients did not attend. Pre-clinic tests were requested in 133 patients and were completed by 86% of the patients who attended. Of patients, 42% were diagnosed and discharged; 28% were listed for surgery, extracorporeal shock wave lithotripsy (ESWL), or referred to another specialty. About 30% of patients needed further out-patient review; in approximately two-thirds to complete a diagnosis and one-third to review the results of therapy initiated. An estimated 350 appointments and 550 patient visits to hospital were saved. CONCLUSIONS: A one-stop method of consultation is efficient across a range of urological presenting complaints, and dramatically reduces the need for follow-up consultations. It has potential to: (i) reduce delays to being seen in out-patients; (ii) lead to more cost-effective care; and (iii) increase safety and patient satisfaction. It should become the standard of care in urology, and is probably applicable in many other disciplines.

[Urological attendance in the Integral Health Center "Alto Palancia": model of primary-specialized integration and unique consultation]. / La asistencia urológica en el Centro Sanitario Integral "Alto Palancia": modelo de integración primaria-especializada y consulta única.

INTRODUCTION AND OBJECTIVE: The progressive increase in the demand of urological attendance demands to establish new welfare models that avoid the saturation of consultations and improve the quality in the attention to the user. The objective of this work is to analyze the improvement of the welfare activity developed in Integral the Sanitary Center Alto Palancia, after the restoration of new welfare models based on integration between Attention Primary and Specialized and the putting in practice of the denominated Unique Consultation. MATERIAL AND METHODS: We analyzed the characteristics of the Center, functions and activity of the specialty developed during year 2002. We described to the application of the model of Unique Consultation and the elements of integration with Primary Attention. We analyzed the improvement of the activity through indicators, that we compared with preceding years. In order to determine the degree of satisfaction of the users we made a survey of opinion of patients and/or taken care of relatives in the Center under the new welfare models. Finally we analyzed the advantages that the applied process presents for the patient and the own sanitary institution. RESULTS: 42% of patients have been taken care of by means of the model of Unique Consultation, being the predominant pathology the HBP in the man and the ITUs in the woman. The time of delay for first visit has been reduced from 49 days in single December 2001 to 3 in December 2002. Single 7.7% of patients discharged from the hospital for pursuit by Primary Attention have been sent again to the specialist. The time that the urólogo dedicates to consultations has reduced in a 29%, being this time dedicated to the accomplishment smaller surgery and final reconnaissances (echography, urodynamic studies and others). The opinion survey has shown a satisfaction of the user very elevated. CONCLUSION: The model of Integral Attention Primary-Specialized and the putting in practice of Unique Consultation applicable to the specialty of Urology, increasing the quality perceived by the user and with evident advantages for the Sanitary Organization.

Improving information for men with postoperative urinary incontinence.

Despite urinary incontinence being a recognised complication of prostate surgery, the physical and psychological needs of men with postoperative urinary incontinence are not well met and there is little written information specifically designed for this group of patients (Moore and Estey, 1999; Harris, 1997). Men rarely seek help for urinary incontinence and I used to feel frustrated at finding that some put up with a continence problem in secret for many years. I decided to explore the reasons for their failing to ask for help and what sort of information they would require if they were going to have prostate surgery. The information I elicited helped me to formulate a strategy to tackle this difficult issue.

[Typification and screening of irregular antibodies. Establishing its use at a urology department]. / Tipificación y detección de anticuerpos irregulares (type and screen). Implantación de su uso en una unidad de urología.

OBJECTIVES: To achieve a better use of the packed red blood cells stock at our centre's blood bank, and to analyse cost-savings associated with the implementation of the type and screen (T/S) technology. METHODS: We analyse the results, complications and cost-savings achieved with the use of T/S at the Urology Department in our centre, for the transurethral resection of bladder tumour and prostate. RESULTS: A total of 232 T/S were performed; 3 patients required blood transfusions (1.3%). No complications appeared. Total cost-savings from December 1999 to December 2001 were 7.620 Euros (1,267,861.3 pesetas). CONCLUSIONS: T/S is a safe procedure allowing a better use of blood stocks in a hospital with a substantial economic saving.

Implementing an ambulatory surgical unit in pediatric urology.

Health care professionals have been asked to do more with less and examine every possible option to cut costs but not service. To meet this challenge, a pediatric urology same-day admit/day care unit provides patients and their families with surgical and diagnostic care that has been well received by patients, families, and staff.

[Rate of external consultation utilization. Organizational and managerial basis of a urology service]. / Tasa de frecuentación de consulta externa. Base organizativa y de gestión de un servicio de urología.

INTRODUCTION: The frequency of visits to an outpatients office is indicative of the proportion of population to be served at that location. MATERIAL AND METHOD: Analysis of the frequency of new cases to an outpatients office over one year and correlation with the conditions treated over the corresponding period. OBJECTIVES: To know the overall frequency of new cases, by condition, affected organ and group of diseases. To know the percentage of surgical resolution of those conditions. To infer from these data the resources necessary in terms of offices, operating theatres and staff RESULTS: The outpatients office shows an overall frequency of new cases of 124/10000 people/year. The highest frequencies by condition, affected organ and group of diseases correspond to BPH, inguinoscrotal area and andrology. 35% of all new cases are managed surgically. 17.5% BPHs and 16.4% prostate carcinomas undergo surgery. The necessary resource are inferred to be: 1.5 ambulatory operating theatres/week, 2-2.5 central operating theatres/week. 5-6 office visits/week and 3 urologists. CONCLUSIONS: The study on the frequency of visits to the outpatients office is a useful tool for the organization and management of the Urology Service.

[Problems raised by representation of activities in urology. Cooperative study by the urology services of the AP - HP (Public Services - Paris Hospitals)]. / Problèmes posés par la représentation de l'activité en Urologie. Travail coopératif des services d'urologie de l'AP-HP.

Paris public hospital urology departments conducted a study which had three objectives: - to test the indicators of activity to determine whether they were well adapted to measurement of the surgical activity performed, - to determine the contribution of the PMSI to the measurement of this activity, - to propose actions designed to improve the representation of the surgical activity actually performed by urology departments. The results of this study show that one half of the operations performed do not correspond to the field of PMSI (day-only admissions, outpatients department). The indicators currently used for budget allocation or interdepartment comparisons of activity are inadequate and, most importantly, induce deformities, variable from one department to another, which severely affect the image of the activity produced by these indicators. Two main reasons can explain these deformities: - the use of the NGAP and the score to measure activity: there is a marked variation of the score for the same operation, from one department to another. - the very poor census of activity performed in outpatient surgery. These two reasons are not related to the medical activity. Definition of a unique nomenclature for surgical procedures would constitute a great progress, provided that this nomenclature allows us to accurately describe our activity and can be modified according to our needs. Although the PMSI is a marked improvement of the information system, its application, in its current state, will not radically change the situation. The PMSI must be enlarged in one way or another, to outpatient activity including procedures performed in the outpatients department. For these measuring tools of activity, which determine the calculation of our budgets, to be adapted to our practice, we must be able to analyse their relevance and introduce changes. We need to develop this field of medico-economic research in urology.