Rapid access urology clinics had been trialled elsewhere in the country with variable success. ED, urology consultants and registrars, and senior nurses (i.e. the stakeholders who would be directly impacted by this intervention) were involved in the decision to convert two side rooms to such a clinic in our DGH. The aim was to see non-elective urology patients efficiently to ensure prompt management and avoid admission where possible.

The proposal and initial data were discussed in the monthly urology governance meetings. The pilot started in August 2018. Patients could be referred by ED, GP, other hospital departments via the on call urology registrar or self-refer. Patients discharged from the urology ward were informed about this, as were ED staff, GPs, and other departments such as radiology and oncology. Feedback from patients and ED staff were welcomed and outcomes measured.

Data was collected prospectively during an initial 47-day pilot period and the subsequent three months. Each attendance was reviewed individually. The hot clinic saw 107 patients in the pilot period and 217 in the subsequent three months. ED avoidance was estimated at 61% in the trial period and 43% in the subsequent period. Length of stay prior to hot clinic was 3.63 days, 2.57 days in the pilot period and then went down further to 1.7 days – to 53% of baseline. Admission avoidance was 41% in pilot and 32% subsequently.

The Urology Hot Clinic has had a significant impact on reducing ED attendance and length of stay of urology patients in our hospital, and on admission avoidance. It has streamlined the patient pathway reducing burden on multiple departments and patients. The success of the hot clinic at our hospital could serve as an example for other urology departments and potentially other specialties.