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Urology -6 Years of Data “What have we learnt?”
Eamonn Rogers
Consultant Urologist
University College Hospital Galway
Urology Clinical Advisor to NCPS
RCSI
NCPS
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)
NCPS use HIPE data for reports 5
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
NCPS use HIPE data for reports 6
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
NCPS use HIPE data for reports 7
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
NCPS use HIPE data for reports 8
Cystoscopy represent
60% of day case
Urology activity and 55%
of all activity
ProcDesc (Code) Inpat BDU AvLOS Inpat BDU AvLOS
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
NCPS use HIPE data for reports 9
ProcDesc (Code) Inpat BDU AvLOS Inpat BDU AvLOS
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
NCPS use HIPE data for reports 10
Nephrectomy by hospital in 2015
NCPS use HIPE data for reports
11
ProcDesc (Code) Inpat BDU AvLOS Inpat BDU AvLOS
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
NCPS use HIPE data for reports 12
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
NCPS uses NTPF waitlist data for reports
Outpatient waiting list for Urology – 26% increase in 1 year (31 Jan’17)
31/1/2017 04/02/2016
NCPS uses NTPF waitlist data for reports
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
NCPS uses NTPF waitlist data for reports
IP/DC wait list 9 months and over for Urology – month end Aug’11 … Jan’17
NCPS uses NTPF waitlist data for reports
IP/DC waiting list for Urology – 29% increase in 1 year (as at 31 Jan’17)
31/1/2017 04/02/2016
NCPS uses NTPF waitlist data for reports
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 )
St Vincent's ( 447 )
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 )
St Vincent's ( 472 )
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)