Emily Hamstead
Introduction
Hospital stays are associated with nosocomial infections, thromboembolism, and deconditioning in older patients. Given current pressures within the NHS, optimising day surgery pathways is key. This audit looked at our rate of day case TURBT to identify how we could improve, in line with the Getting It Right First Time (GIRFT) target of 60%.
Method
A retrospective audit was performed of elective TURBT over a 6 month period in 2022. Demographic data were collected, along with details of the initial waitlisting process, the procedure itself, and reasons for admission postoperatively.
2 further cycles were completed following intervention; closing the loop. A key intervention was default day case listing, unless otherwise contraindicated.
Results
Initially, 23.1% were discharged the same day. After intervention: 62% were discharged the same day, despite no difference in demographic data (median ASA grade 3 across all cycles; average age 76 years).
Reasons for admission included: ongoing irrigation, monitoring after extensive procedure, patient factors, and need for trial without catheter.
80% were catheterised across all cycles, despite only ~30% receiving mitomycin.
Conclusion
This audit has shown that, with only simple intervention, we significantly improved the rate of day case TURBT, in line with the GIRFT target. Despite an older, multi-comorbid patient group, the expected barriers to performing day case TURBT have not impeded our centre from meeting the GIRFT target. There is still room to improve; further work may centre around the rate of catheterisation and focus on streamlining this element of patient care.
Authors
Emily Hamstead
York and Scarborough Teaching Hospitals, York, United Kingdom