Urology -6 Years of Data “What have we learnt?” - rcsi.ie Eammon .pdf · Urology -6 Years of...

Urology -6 Years of Data “What have we learnt?”

Eamonn Rogers

Consultant Urologist

University College Hospital Galway

Urology Clinical Advisor to NCPS

RCSI

Outpatient Waiting

list 31/01/2017 04/02/2016

Specialty

31/01/17

Total

04/02/16

Total

1 Year

%

Change

Orthopaedics 56,822 45,171 26%

Otolaryngology (ENT) 55,925 46,716 20%

General Surgery 33,738 35,045 -4%

Ophthalmology 33,509 25,051 34%

Urology 25,646 20,318 26%

Plastic Surgery 12,958 11,556 12%

Vascular Surgery 7,359 7,256 1%

Neurosurgery 4,650 4,237 10%

Maxillo-Facial 4,170 3,043 37%

Paediatric ENT 2,226 1,496 49%

Oral Surgery 2,168 1,289 68%

Breast Surgery 1,706 1,690 1%

Paediatric Surgery 353 358 -1%

Dental Surgery 272 222 23%

Cardio-Thoracic Surgery 196 171 15%

Gastro-Intestinal Surgery 112 257 -56%

Hepato-Biliary Surgery 99 18 450%

Paed Orthopaedic 94 66 42%

Paediatric Neurosurgery 4 15 -73%

Grand Total 242,007 203,975 19%

Day Case & Inpatient

Waiting list 2017-01-31 2016-02-04

Specialty

31/01/17

Total

04/02/16

Total

1 Year %

Change

General Surgery 19,410 16,593 17%

Ophthalmology 12,916 11,406 13%

Orthopaedics 11,469 10,031 14%

Urology 9,140 7,095 29%

Otolaryngology (ENT) 7,530 6,951 8%

Plastic Surgery 5,829 4,599 27%

Vascular Surgery 2,866 2,560 12%

Oral Surgery 914 937 -2%

Gastro-Intestinal Surgery 849 780 9%

Maxillo-Facial 694 749 -7%

Neurosurgery 608 648 -6%

Cardio-Thoracic Surgery 478 491 -3%

Dental Surgery 343 312 10%

Paediatric ENT 259 247 5%

Hepato-Biliary Surgery 189 131 44%

Paediatric Surgery 164 67 145%

Breast Surgery 100 55 82%

Paed Orthopaedic 0 35 -100%

Grand Total 73,758 63,687 16%

Surgical waiting list volumes by specialty 31st Jan’17 compared to previous year.

Discharges following Surgical procedure in 2015

Urology

NCPS use HIPE data for reports 4

Urology Discharges by hospital in 2015 (including Acute and Elective admissions for surgery)


Top 15 primary procedure by volume

ProcDesc (Code) Inpat BDU AvLOS Inpat BDU AvLOS

Cystoscopy (3681200) 541 8,010 14.8 304 1,224 4.0 14,585 15,430

Transrectal needle biopsy of prostate (3721900) 22 119 5.4 29 82 2.8 2,992 3,043

Endoscopic removal of ureteric stent (3683301) 98 536 5.5 51 140 2.7 1,041 1,190

Endoscopic destruction ureteric lesion (3680901) 440 1,567 3.6 201 582 2.9 175 816

Transurethral resection of prostate (3720300) 97 1,202 12.4 640 2,471 3.9 9 746

Endoscopic insertion of ureteric stent (3682101) 450 3,504 7.8 108 445 4.1 122 680

Endosc resec lsn / tiss bladder <= 2 cm (3684002) 74 842 11.4 324 1,142 3.5 61 459

Endoscopic biopsy of bladder (3683600) 39 624 16.0 107 384 3.6 307 453

Endoscopic replacement of ureteric stent (3682103) 75 966 12.9 115 355 3.1 207 397

Excision of hydrocele (3063100) 15 93 6.2 91 160 1.8 273 379

Endosc dest bladder lsn / tiss <= 2 cm (3684003) 20 247 12.4 89 174 2.0 195 304

Percutaneous nephrostomy (3662400) 201 3,588 17.9 42 739 17.6 20 263

Ureteroscopy (3680300) 89 378 4.2 48 93 1.9 121 258

Percutaneous cystotomy [cystostomy] (3701100) 97 1,567 16.2 37 171 4.6 116 250

Orchidectomy, unilateral (3064100) 95 496 5.2 75 142 1.9 67 237

Acute Elective

Day CasesTotal

Discharges

Variation in • Volumes, • AvLOS & • day case proportion

86.7% of activity

Stay Pat.

AvLOS: 10.1 10.4 9.4 9.9 9.7 10.1

Stay Pat.

AvLOS: 5.5 5.4 5.1 4.9 4.9 4.8

DC rate 79.8% 81.4% 82.1% 83.4% 84.6% 83.9% SD Rate 1.5% 2.8% 3.0% 3.1% 3.8% 4.9%

Emergency – increasing volume, increasing SD rate & AVLOS back to 2010 level

Elective – increasing volume, increasing DC rate & decreasing AVLOS

Urology Discharges & Bed Day Usage by Qtr (2010…2015) – had a urology surgical procedure


Stay Pat.

AvLOS: 7.4 7.5 6.8 6.9 6.9 7.2

DC/SD rate70.4% 72.0% 73.9% 75.1% 76.5% 74.3%

Urology Discharges & Bed Day Usage by Qtr (2010…2015) – had a urology surgical procedure Combined Elective & Emergency –

increasing volume, increasing SD/DC rate & decreasing AVLOS

2010 2011 2012 2013 2014 2015

Treated PerQtr 5,892 5,994 6,474 6,646 6,912 7,204

AvgBDU PerQtr 14,900 14,712 13,867 13,969 13,769 15,996

Elective & Emergency – 2010…2014: efficiency gains faster then volume increase 2015: volume increase & small efficiency loss ≈ 27.5 beds


Combined Elective & Emergency – increasing volume,

increasing SD/DC rate & decreasing AVLOS

Stay Pat.

AvLOS: 5.0 5.4 4.8 4.9 4.8 4.7

DC/SD rate68.4% 69.7% 74.1% 75.5% 75.5% 80.1%

Urology Discharges & Bed Day Usage by Qtr (2010…2015) – did NOT have urology surgery

2010 2011 2012 2013 2014 2015

Treated PerQtr 3,038 3,238 3,932 4,254 4,397 4,092

AvgBDU PerQtr 5,857 6,433 6,309 6,735 6,833 5,482

Elective & Emergency – 2010…2014: efficiency gains Slower then volume increase

2015: volume drop & efficiency gain ≈ 16.5 beds


Cystoscopy represent

60% of day case

Urology activity and 55%

of all activity


Cystoscopy (3681200) 539 8,004 14.8 296 1,209 4.1 14,499 15,334

Acute Elective

Day CasesTotal

Discharges

Cystoscopy Discharges by hospital in 2015

Day case rate for elective Cystoscopy has improved

from 95.2% in 2010 to 97.9% in 2015

Elective Cystoscopy trend by Qtr 2010…2015

HIPE 2015



Endoscopic removal of ureteric stent (3683301) 98 536 5.5 51 140 2.7 1,041 1,190

Endoscopic insertion of ureteric stent (3682101) 450 3,504 7.8 108 445 4.1 122 680

Endoscopic replacement of ureteric stent (3682103) 75 966 12.9 115 355 3.1 207 397

Acute Elective

Day CasesTotal

Discharges

Insertion, removal or replacement of Ureteric stent by hospital in 2015

Day case rate for elective Endoscopic Insertion, Removal

or Replacement of Ureteric stent

increased from 74.0% in 2010

to 83.2% in 2015

HIPE 2015


Nephrectomy by hospital in 2015

NCPS use HIPE data for reports

11


Laparoscopic radical nephrectomy (3652800) 15 145 9.7 113 671 5.9 0 128

Radical nephrectomy (3652801) 17 352 20.7 94 915 9.7 0 111

Partial nephrectomy (3652201) 5 45 9.0 90 796 8.8 0 95

Complete nephrectomy, unilateral (3651601) 7 233 33.3 33 334 10.1 0 40

Laparoscopic partial nephrectomy (3652200) 4 127 31.8 28 176 6.3 0 32

Lap nephrectomy trnsplnt, l iving donor (3651604) 0 0 30 161 5.4 0 30

Grand Total 48 902 18.8 388 3,053 7.9 0 436

Acute Elective

Day CasesTotal

Discharges

NQAIS Surgery

Dec’15..Nov’16

# # ## #

# #

# #

# #

# #

Lap. radical nephrectomy Radical nephrectomy Partial nephrectomy

88 7.8

7 9.4

27 5.1

6 12.0

8 6.3

105 8.5

11 7.5

7 6.3

5 10.2

8 6.9

146 5.7

9 4.5

31 4.9

15 6.2

5 4.4

NQAIS Surgery – Nephrectomy – variation in Volumes and AvLOS by consultant in 2015


Outpatient waiting list for Urology – month end Mar’13 … Jan’17

NCPS uses NTPF waitlist data for reports

Outpatient waiting list 9 months and over for Urology – month end Mar’13 … Jan’17


Outpatient waiting list for Urology – 26% increase in 1 year (31 Jan’17)

31/1/2017 04/02/2016


Outpatient

Waits 0-3 Months 3-6 Months 6-9 Months

9-12

Months

12-15

Months

15-18

Months

18-21

Months 21-24 Months

24-36

Months

36-48

Months 48+ Months Grand Total

31/01/2017 7,182 4,947 3,669 3,285 2,186 1,499 1,045 753 993 80 7 25,646

04/02/2016 7,402 4,401 3,148 2,805 1,730 424 183 128 91 3 3 20,318

% 1 Yr change -3% 12% 17% 17% 26% 254% 471% 488% 991% 2567% 133% 26%

Tallaght Adult ( 2,060 )

UH Limerick ( 1,694 )

UH Waterford ( 1,668 )

Galway UH ( 1,660 )

Beaumont ( 1,578 )

Mater ( 1,488 )

Cork UH ( 1,324 )

St James's ( 1,190 )

Mercy ( 1,148 )

St Vincent's ( 901 )

Connolly ( 894 )

Letterkenny ( 822 )

Drogheda ( 812 )

Portlaoise ( 527 )

Sligo ( 453 )

UH Waterford ( 3,332 )

Tallaght Adult ( 2,936 )

Galway UH ( 2,573 )

UH Limerick ( 2,035 )

St James's ( 1,885 )

Mater ( 1,756 )

Cork UH ( 1,495 )

Beaumont ( 1,228 )

St Vincent's ( 1,157 )

Mercy ( 1,055 )

Drogheda ( 1,017 )

Letterkenny ( 851 )

Connolly ( 807 )

Temple st ( 672 )

Portlaoise ( 608 )

IP/DC waiting list for Urology – month end Aug’11 … Jan’17


IP/DC wait list 9 months and over for Urology – month end Aug’11 … Jan’17


IP/DC waiting list for Urology – 29% increase in 1 year (as at 31 Jan’17)

31/1/2017 04/02/2016


Day Case &

Inpat Wait 0-3

Months

3-6

Months

6-8

Months

8-12

Months

12-15

Months

15-18

Months

18-24

Months

24-36

Months

36-48

Months

48+

Months

Grand

Total

2017-01-31 3,392 2,215 876 1,240 582 505 287 43 0 0 9,140

2016-02-04 2,611 1,707 918 1,128 523 150 36 17 4 1 7,095

% 1 Yr change 30% 30% -5% 10% 11% 237% 697% 153% -100% -100% 29%

Galway UH ( 2,029 )

Beaumont ( 824 )

UH Waterford ( 691 )

Mater ( 663 )

Ennis ( 541 )


Tallaght Adult ( 406 )

Connolly ( 392 )

Cork UH ( 374 )

St James's ( 355 )

Nenagh ( 343 )

Sligo ( 282 )

Drogheda ( 263 )

Mercy ( 254 )

UH Limerick ( 252 )

Galway UH ( 1,869 )

Beaumont ( 903 )

Mater ( 721 )


Tallaght Adult ( 342 )

St James's ( 337 )

Mercy ( 274 )

Cork UH ( 266 )

Ennis ( 233 )

Sligo ( 203 )

Connolly ( 195 )

Portlaoise ( 190 )

St John's ( 186 )

Letterkenny ( 186 )

UH Limerick ( 167 )

The Future

• Comparative international criteria in Urology – AVLOS and LOS and Day Care

• Elective Cancer / Reconstruction /Complex Stones

• Robotics

• Laparoscopic

• Open

– Designated Centres ?

The Future

• Outpatient Strategies

– OSPIP/NCCP/NCPS • Direct Referral • One stop Haematuria Clinic

– OSPIP /NCPS LUTS Pathway • Shared care path designed with Primary Care • Electronic referral • Decision making tools • Virtual Clinic • Nurse led clinic

• Inpatient / Day Care Strategies

• HUB AND SPOKE (60% waiting list = Cystoscopy = Ambulatory)

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