Cystoscopy:75 years on

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Cystoscopy75 years on
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Urology Directorate Cystoscopy GRS Project Urology Directorate Cystoscopy GRS Project


Introduction Flexible 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.
Aim The 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.
Tools In conjunction with tailored software we can standardise the information to ensure consistent data recording, monitor procedure completion rate 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.
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Urology Directorate Cystoscopy GRS Project Urology Directorate Cystoscopy GRS Project


Flexibility of Project Cystoscopy nurse left
post Alternative software product Enhanced
utility Quarter of cost
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Flexible cystoscopythe challenge

• Highest incident procedure in urology
• Diagnostic and surveillance utility

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CCIthe process

• Analysis-understanding the patient journey
• Understanding the system-demand ,capacity
  ,activity and backlog
• Measurement
• Queueing theory

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CCI Project the result

• 9 week wait

• Teamwork

• Improved referral pathways
• One stop clinics
• Pooling of waiting lists
• Increased flexibility of working
• Increase in capacity

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Better Health Better Care Action Plan 6
Dimensions of Quality

• Timeliness
• Patient centred
• Safe
• Effectiveness
• Equitable
• Efficient

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Flexible cystoscopy and the Global Rating
Scale(GRS)

• How many flexible cystoscopies per annum/ per
  consultant in Scotland?
• Which guidelines do you use? BAUS
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  EAU
• 
  AUA
• What evidence can you produce for
  revalidation/recertification about
  quality/outcome of your flexible cystoscopies?

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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
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• What has the GRS achieved?

www.grs.nhs.uk
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GRS National resultsone item - six censuses
over 2.5 years (207 units)
level B or better is the current standard for an
acceptable service
scoring A or B
04/07
10/07
10/06
04/06
04/07
10/06
10/05
10/05
04/05
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Endoscopy Global Rating Scale
The patient experience
P
2 dimensions clinical quality quality of
the patient experience
1 2
12 patient centred items
1 2 3 4 5 6
Each item has four levels A-D (descriptors)
D C B A
Each level is underpinned with 1-5
measures
1 2 3
www.grs.nhs.uk
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• Summary

• Allow us to address the quality dimensions
• Provide an audit tool
• Improve the quality and safety of flexible
  cystoscopy