What Happens When There is No Weekend Urology Cover? An Audit and Formation of a New Care Pathway

Abstract

Objective: An audit was conducted to find out whether there is any unnecessary delay in discharging patients after transurethral resection of the prostate (TURP). Methods: About 94 patients who underwent elective TURP over a period of seven months between April 2002 and October 2002 at Darent Valley Hospital were selected. Details were collected from the case-notes retrospectively. Results: The mean age of patients was 72.71 (range 57–90) and the mean postoperative hospital stay was 4.7 days (range 2–20). In all, 30 patients stayed for less than three days and 64 (68.1%) patients stayed for longer duration. Among these 64, 37 had underlying reasons for their prolonged stay and 27 (42%) had no obvious reason for their delay in discharge. Among these 27 (mean stay − 4.42 days), 16 (59.25%) were operated upon on Friday, eight (29.62%) on Thursday, three (11%) on Wednesday and none were operated upon on Monday. Discussion: Patients undergoing operations on Thursday and Friday stayed longer because of lack of urological cover during the weekend. Complications such as urinary tract infection (UTI) and excess bleeding can be minimized by implementing strict preoperative urine culture, antibiotic prophylaxis and spending a little extra time on haemostasis. If a patient fails his trial without a catheter it should not be removed again during the same admission. An anticoagulation nurse can help to reduce the stay for patients on warfarin. Nurses and junior doctors should be taught about how to reduce postoperative stay after TURP. A new care pathway, which allows nurses to remove the catheter without waiting for instructions, may be useful. A prospective audit is recommended.