Open AccessImplementing and evaluating the efficacy of an acute care urology model of care in a large community hospital
Author(s) -
Abirami Kirubarajan,
Roger Buckley,
Shawn Khan,
Rebecca Richard,
Veselina Stefanova,
Nicole Golda
Publication year - 2020
Publication title -
canadian urological association journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.477
H-Index - 38
eISSN - 1920-1214
pISSN - 1911-6470
DOI - 10.5489/cuaj.6371
Subject(s) - medicine , renal colic , referral , emergency department , emergency medicine , patient care , kidney stones , outpatient clinic , family medicine , nursing , alternative medicine , pathology
We implemented an acute care urology (ACU) model at a large Canadian community hospital to determine the impacts on safe and timely care of patients with renal colic. The model includes a dedicated ACU surgeon, a clinic for emergency department (ED) referrals, and additional daytime operating room blocks for urgent cases.
Methods: We conducted a chart review of 579 patients presenting to the ED with renal colic. Data was collected before (pre-intervention, September to November 2015) and after (postintervention, September to November 2016) implementation of the ACU model. Secondary methods of evaluation included surveying patients and 20 ED physicians to capture subjective feedback.
Results: Of the 579 patients presenting with renal colic,194 were diagnosed with an obstructing kidney stone and were referred to urology for outpatient care. The ED-to-clinic time was significantly lower for those in the ACU model (p<0.001). Furthermore, the ACU clinic resulted in significantly more patients being referred for outpatient care (p=0.0004). There was also higher likelihood that patients would successfully obtain an appointment post-referral (p=0.0242). The number of after-hours and weekend surgeries decreased significantly after dedicated ACU daytime operating room (OR) blocks were added in Sep 2015 (p<0.0001). All surveyed patients rated the care as either “excellent” or “very good,” and all physicians believed the ACU model has improved patient care.
Conclusions: The ACU model has shown benefit in ensuring timely followup for ED patients, reducing use of after-hour OR time, and improving patient and physician satisfaction.