Provision of 'walk-in' nursing service from Nurse-led clinic reduce the unnecessary emergency attendance and admission

Abstract

Introduction and objectives: The number of urological patients discharged from ward, ambulatory day centre and diagnostic centre everyday after different kinds of procedure, operation and investigation was large. Some of them may require short term or long term nursing support such as catheter care including percutaneous nephrostomy tube (PCN), urethral catheter and supra-pubic catheter (SPC), stoma care, continous intermittent self catheterization (CISC) reassessment. Lack of extended nursing support may increase unnecessary emergency attendance and admission. To avoid unnecessary emergency attendance and admission of urological patients especially for those patients require long-term medical or nursing care. Materials and methods: Patients with PCN, urethral catheter and SPCalways face problem of urine leakage, blockage of catheter, haematuria,pain or lossen of stitches over insertion site. In addition, paitents failedto perform self-catheterization or post urological procedure fail to voidwere common. They usually attended the Accident and EmergencyUnit and sometimes required admission to urology ward. In order toprevent unncessary emergency attendance and admission, patient couldwalk in or contact the Urology Nurse-led clinic for advice if theyencountered catheter-related problems, stoma related problems or posturological procedure complications. They could receive immediateurological management including nursing assessment, intervention andmanagement. If patient’s problem could not be treated in the clinic,they could directly admit to Urology ward after assessment byurologist. Results: There were total 66 patients attended Urology Nurse-ledclinic in 2016. As compared to 2015, there were 43.5% increased ofattendance. These patients required (1) emergency urethral catheterinsertion after trans-rectal ultrasound guided prostate biopsy failed tovoid or found large residual urine post uroflowmetry investigation(19.7%), (2) post operative wound or stoma care (19.7%), (3) urethralcatheter care due to leakage or blockage (30.3%), (4) PCN care relatedto skin problem or tube blockage (25.8%), (5) re-education on CISCdue to difficulty on insertion or pain (3%) and (6) direct admission toUrology ward due to post investigation fever (1.5%). Furthermore,none of the above patients required emergency admission to Urologyward within 30 days after the attendance in Urology Nurse-led clinic.Conclusion Majority of the patients with catheter or post urologicalprocedure were discharged directly from the ward and Urology centreafter prompt management. Thus, the provision of “Walk-In” nursingservice at Urology Nurse-led clinic could apparently provide immediatemanagement to avoid unnecessary emergency attendance or admissiondue to catheter related problems and post urological procedurecomplications. In the future, further expansion of the scope of servicesprovided by Urology Nurse-led clinic can offer more alternatives topatients under different circumstances.