cystoscopy:75 years on
DESCRIPTION
Cystoscopy:75 years on. ? . Flexibility of Project Cystoscopy nurse left post Alternative software product Enhanced utility Quarter of cost. Flexible cystoscopy:the challenge. Highest incident procedure in urology Diagnostic and surveillance utility. CCI:the process. - PowerPoint PPT PresentationTRANSCRIPT
Cystoscopy:75 years on
Urology DirectorateCystoscopy GRS ProjectIntroductionFlexible cystoscopy is the core urological diagnostic procedure. In Scotland this comprises 56% of the day case workload and 28% of the total urological workload.
We have successfully reduced the waiting time through the development of agreed referral pathways, nurse-led / same day vetting and straight to test booking. However the issues surrounding the quality and safety of the patient-centred procedure have not yet been examined.
AimThe aim of the project is to develop a quality assessment tool to measure the performance of cystoscopy units in achieving the six dimensions of quality as outlined in ‘Better Health, Better Care’(2007); namely patient centred, safe, effective, equitable and efficient care.
The Global Rating Scale (GRS) has been used in Scotland within endoscopy units to assess quality of care. This tool will be adapted for flexible/GA cystoscopy to establish a national reporting system, creating a national standard for flexible cystoscopy.
ToolsIn conjunction withtailored software we can standardise the information to ensureconsistent datarecording, monitorprocedure completionrate and generate immediate results for patients and clinicians. The use of regular patient feedback surveys will allow benchmarking of services and enable us to identify potential improvements in efficiency on an ongoing basis.
?
Urology DirectorateCystoscopy GRS Project
Flexibility of Project
Cystoscopy nurse left post
Alternative software productEnhanced utilityQuarter of cost
Flexible cystoscopy:the challengeHighest incident procedure in urology
Diagnostic and surveillance utility
CCI:the process• Analysis-understanding the patient journey• Understanding the system-
demand ,capacity ,activity and backlog• Measurement• Queueing theory
CCI Project :the result
9 week wait• Improved referral
pathways• One stop clinics• Pooling of waiting lists• Increased flexibility of
working • Increase in capacity
Teamwork
Better Health Better Care Action Plan: 6 Dimensions of Quality• Timeliness• Patient centred • Safe• Effectiveness• Equitable• Efficient
Flexible cystoscopy and the Global Rating Scale(GRS)• How many flexible cystoscopies per annum/
per consultant in Scotland?
• Which guidelines do you use? BAUS EAU AUA• What evidence can you produce for
revalidation/recertification about quality/outcome of your flexible cystoscopies?
Endoscopy Global Rating ScaleNational census twice yearly (April and October)
• Following a pilot in September 2004 six national censuses have been held at six month intervals
• The GRS is now used as the quality standard for JAG and bowel screening accreditation visits
www.grs.nhs.uk
What has the GRS achieved?
www.grs.nhs.uk
10/06
10/05
04/07% scoring A or B
GRS – National resultsGRS – National resultsone item -one item - six censuses over 2.5 years (207 units)six censuses over 2.5 years (207 units)
04/05
04/06
10/0610/05
04/07
level B or better is the current standard for an acceptable service
10/07
D C B A
1 2 3 4 5 6+ 12 patient centred items
Each item has four levels A-D (descriptors)
Each level is underpinned with 1-5 measures
1 2 3
Endoscopy Global Rating ScaleThe patient experience
2 dimensions: clinical quality & quality of thepatient experience
1 2P
www.grs.nhs.uk
Summary Allow us to address the
quality dimensions
Provide an audit tool
Improve the quality and safety of flexible cystoscopy