A urological urgent assessment unit service evaluation in a United Kingdom hospital

Abstract

What are the experiences, evaluations and satisfaction levels of service users requiring ambulatory, urgent and emergency urological care who attended a newly implemented urology assessment unit (UAU) in a National Health Service (NHS) hospital in the United Kingdom (UK)? A UAU within an acute care setting was set up for ambulatory, emergency and urgent urological care. The objectives of the unit was to improve patient satisfaction, divert patients from the emergency department, provide an area for early specialist review, allow earlier discharge from hospital and prevent unnecessary admissions to hospital. The aim of this service evaluation (SE) was to evaluate the service user experience and satisfaction when attending this unit. Surgical assessment units are well-supported in terms of reducing admissions and diverting patients from emergency departments, however, there is little published research regarding units specifically for urology. Important sources involved in urological care delivery and services advocate their implementation but there remains very little published evidence to support this. Opinion pieces and short case studies have yielded positive results. No research was found that has looked into patient satisfaction, experience and feedback of these units in any detail. A SE was conducted involving sending a postal questionnaire to a random selection of 150 patients who attended the UAU. The questionnaire contained a set of 13 Likert-style questions with additional free text open-ended questions for provision of further clarification and service user expression. Questions around age, reason for admission and accessibility to the UAU were also included. The Likert-style and demographic questions were analysed by quantifying responses to percentages and the open-ended responses were analysed thematically. The questionnaire response rate of 51% was seen from 76 respondents and these were most commonly over 71 years old (47%). The most common reasons for attending were urinary retention, infection and post-operative urological problems. Of these, 22% did not need to see a doctor and were treated and discharged by the urology nurse practitioner. The care on the UAU was rated highly and generally found to be preferable over the care provided by emergency departments (ED) and general practitioners (GP) family doctors and patients were grateful to avoid being admitted to hospital. Patients appreciated easy access to specialist care and knowledge. Good levels of communication were highlighted as important. Open-ended response themes included; nursing, doctors, environment, access, communication, specialist access, preventing ED attendances and hospital admissions. Participants rated the care from the nurses and doctors highly; there was a focus on appreciating seeing a specialist directly and avoiding admission to hospital. They were satisfied with being able to avoid attending their GP or ED, and generally preferred the unit over these routes of care. There are multiple areas within emergency and urgent urological care that require further research.