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Model of care for urology proposes radical change in treatment delivery

A model of care for the treatment of urological conditions in Ireland was launched today at Roscommon University Hospital (RUH) by RCSI President Mr Kenneth Mealy.

Developed by RCSI in partnership with HSE Acute Operations and the National Clinical Programme in Surgery (NCPS), Urology: A model of care for Ireland outlines a radical change in the delivery of urology care so that the majority of urology patients are cared for in the community. 

The model of care envisages a system of urology care that serves the majority of patients in the community, such as primary care centres or in their local hospital, while assuring appropriate clinical governance to support a safe and high-quality service.

RUH is the primary pilot site for a one stop rapid access haematuria pathway (RAHP) clinic providing access to diagnostics for patients who have symptoms of blood in the urine, with procedures and investigations carried out within 28 days. The RAHP clinics are one of the key improvement initiatives within this model of care

Mr Eamonn Rogers, the NCPS Clinical Advisor in Urology, was commissioned by the HSE to undertake this work. Speaking ahead of the launch, Mr Rogers said: “The frequency of urinary symptoms and pathology increases with age. Ireland’s changing demographics mean that a radical reconsideration of how best to deliver urology services is necessary.

“This model of care must be implemented in full so that we can deliver an efficient and economically viable service which improves the access of patients across Ireland to the services they require as they get older, delivered by a range of healthcare providers including general practitioners, physiotherapists, and clinical nurse specialists, advanced nurse practitioners, physician associates and urologists.”

Welcoming the publication of the model of care, Dr Vida Hamilton, National Clinical Advisor and Group Lead, Acute Operations of the HSE (NCAGL), commented: “This model of care was developed in collaboration with a wide range of stakeholders and outlines an integrated and multidisciplinary approach to urology services. Its publication is welcomed and its implementation will improve services and patient outcomes.”

Prof Deborah McNamara, Co-Lead of the NCPS, said: “The development of specialty models of care is the next step in defining best practice. It allows a deeper understanding of the range of activity delivered by specialist services and of areas where there are unmet needs.

“It is also an opportunity for each specialty in surgery to define how the multidisciplinary surgical workforce can best deliver the care required by Irish patients, taking into consideration the new ways of working that are now the standard of care. Improvement of surgical services will require specialties to consider new ways of working, including the migration of some procedures towards ambulatory treatment instead of inpatient care.

 “New technology has the potential to change not only the diagnostic and therapeutic procedures that can be performed, but also the way that surgeons communicate with patients, interdisciplinary team members, colleagues in the community and their fellow surgeons. The starting point for the development of specialty models of care must remain the needs of Irish patients and our responsibility to ensure that these services are accessible, safe, equitable and of high quality,” added Prof McNamara.

According to Prof John Hyland, Co-Lead of the NCPS, “Implementation of this model of care and its nineteen recommendations will be critical to enable every urology patient to benefit from quality improvement in all aspects of their healthcare journey.”

The NCPS is an initiative of the HSE and RCSI. An important role of NCPS is defining the standards of care that should apply to surgical care in Irish hospitals.

The programme has previously published models of care for acute surgery, elective surgery, and otolaryngology head and neck surgery.

Urology: A model of care for Ireland is available for download at: http://rcsi.ie/files/surgery/docs/20190904092141_Specialty Models of Care Urolo.pdf

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