Authors (including presenting author) :
WY Yung, ML Li, JWM Tsang, LH Wan, LY Wong, GYK Lu, VSH Lau, KK Chan, WY Cheung, WY Ho, WC Yu, MK Chan, KC Ma, SK Chu, CW Man, LH Chau, MTY Chan, CH Cheng, YK Lee, TK Lo
Affiliation :
Day Urology Service, Ambulatory Services Centre, Division of Urology, Department of Surgery, Pok Oi Hospital, New Territories West Cluster
Introduction :
Integrated Model of Specialist Out-patient (SOP) Service through Nurse Clinic in various specialties was implemented in April 2018. We had applied the integrated model into Prostate Nurse Assessment Clinic since Nov 2018.
Objectives :
Patient with LUTS/BPH symptoms undergo long waiting time with 1-1.5 year before their first routine consultation within NTWC. Through Prostate Nurse Assessment Clinic facilitate early diagnosis, prevention of complication and continuity of specialist care.
Methodology :
All urology new case referrals were screened by Urologists. Men >45 years old with lower urinary tract symptoms were referred to Prostate Nurse Assessment Clinic in Day Urology Service at POH for investigation before attending their first medical appointment. Nurse clinic sessions will be arranged for preliminary physical examination, investigation and assessment. A nurse clinic follow up (4-6 weeks) after initial assessment will be offered to evaluate symptoms progress, reinforce related health advises and provide medical appointment according to investigation findings screened by Urologists.
895 patients who attended Prostate Nurse Assessment Clinic from 1 Oct 2019 to 31 May 2022 were included for analysis retrospectively from database. Service audit was conducted annually for evaluation of patients’ satisfaction level towards service provided.
Result & Outcome :
Mean (range) age of population was 66.31 (46-94). Average waiting time for initial assessment was 81 days (6-251days). Mean (range) prostatic size was 48.0 cc (12.3-207.3 cc). 310/809 (38.3%) noted elevated PSA (>4ug/L) required further monitoring or intervention. 71/895 (7.9%) found abnormal USG findings include suspicious of hydronephrosis (40), renal stone (11), bladder stone (9), ureteric stone (4), renal mass (3), bladder mass (4). 85/895 (9.4%) patients required P2 medical appointment (2-8weeks). 140/895 (15.6%) offered 2-6 month medical follow up. 187/895 (20.8%) offered 6-month medical appointment. Rest of the population 478/895 (53.4%) received over 6-month medical FU either assessed by Urologist or physician from Family Medicine & Primary Health Care.
Patient also expressed their overall urinary symptoms had been improved after education and interventions provided during first visit from nurse clinic. Mean score of IPSS during first visit was 16.0 while second visit was 14.1. Mean QOL was 3.48 (first visit) and 3.14 (second visit).
Most of patient (98%) satisfied to service provided with satisfaction survey conducted annually (year of 2019, 2021 & 2022)
Conclusion:
The Prostate Nurse Assessment Clinic lead by Urology nurses demonstrates crucial roles which effectively priorities patients who suffered from LUTS/ BPH. Prompt treatment or advises can be delivered by early detection of Urological emergency or abnormalities during triage process. The Integrated Model of SOP further expands the role of nurses towards greater professionalism.
