REMEDY : BNSSG referral pathways

Urgent Care and HOT clinic (Urology)

Checked: 22-10-2018 by Rob.Adams Next Review: 24-10-2019

Service Overview

Urology services in BNSSG are centralised at NBT. The NBT urology on call registrar has a very busy role managing phone calls from GPs, district nurses, and other specialities while trying to manage the most unwell urology patients in the hospital as well as emergency operations. NBT have therefore tried to streamline some of the phone calls to reduce the burden on the on call team. 

NBT aims to see emergency urology patients in either the surgical admission ward (32b) or the surgical hot clinic (32b), instead of seeing them in the emergency department or the seated assessment unit. For advice on how to arrange an admission or refer to the Urology HOT clinic please see below.

Urgent Advice

Advice

If you would like urology advice which is unlikely to need an immediate patient review or admission please call the urology advice line: 0117 414 4958

The line is manned by Jithisha Sudhakaran in the urology department from 09.30-16.30 Mon-Fri. She will take the GP and patient’s details. The on call consultant will call the GP back with advice.  It is helpful to have a direct phone number to contact the GP promptly. 

HOT Clinic

HOT Clinic - how to refer

If you would like a patient to be reviewed in the emergency urology hot clinic please contact the operational HUB on 0117 4140700. The HUB team will ask a few questions to ensure suitability and will book into a urology hot clinic slot on the day or following day. They will let you know the time and day of the slot so you may inform your patients. Please ensure a letter accompanies the patient to hospital.

This service is designed for emergency ambulatory patients. It is an admission avoidance clinic; it is not to bring patients back for review after a previous admission or for chronic problems.

The hot clinic booking is made only by the urology registrar on call or by the HUB.   No other teams can send patients to the urology hot clinic. The HUB books the patients into the outlook calendar and informs the GP of the time slot. 

The HOT clinic is not currently suitable for patients with suspected renal colic - please see section below for details on management of these patients

 

Further information about the Urology HOT Clinic

There are 2/3 rooms, 1 hourly appointments (1.5 hours for slots with US) 7 days a week. There are 3 planned US slots at the weekend (shared with surgery).  This is staffed by one trained nurse and 1 HCA Monday-Friday and one HCA at weekends. 

Patients requiring US testes/renal need ICE requests for these investigations and discussion with the radiology department. The patients requiring US testes should be booked into the 2pm HOT clinic appointment for a 2.30pm US.  This will allow the radiology department to provide sonographers on a majority of occasions who can do US testes.  For scans outside these hours, the urology registrar will need to discuss with the on call radiology registrar.  There should be virtually no CT requests from hot clinic.  CT for ?renal colic should be done in the emergency department. 

Should a urology CT scan be requested the protocol is as follows:

  • The referring clinician will request the scan on ICE and will be expected to discuss the request with the level 0 radiologist prior to the patient arriving in the department. 

  • Once vetted the hot-clinic team will contact CT and should be encouraged to escort the patient to level 0 because of the issues with patient access to level 0 CT. 

  • If the request requires contrast then the patient must be cannulated prior to the patient arriving in CT. 

  • Hot-clinic patients DO NOT take priority over inpatient work so will be subject to delay at times of peak inpatient and ED activity. 

Urology patients should be booked into later clinic slots to facilitate the ward round being completed first. The 5pm handover with the on call consultant should include seeing any patients remaining in the hot clinic. 

Renal Colic

Suspected Renal Colic

Patients with suspected renal colic should be sent to the local emergency department initially to get a CT KUB. GPs who phone to refer patients to urology with suspected renal colic will be advised of this pathway.  If renal stones are confirmed then the emergency department will then refer to the on call urology registrar if the patient needs admitting or to the stone clinic if the patient can be managed as an outpatient. 

Please also see the Renal Calculi section.

Admissions

Admission Requests

If you suspect a patient needs admission please call the operational HUB: 0117 4140700

The operational HUB will transfer the call to the urology registrar (or surgical hospital at night team) to permit discussion and acceptance/re direction of the patient. If accepted, the urology registrar will explain that arrangements will be made for a bed on 32b and the patient will be contacted when a bed is available.  The registrar will take all patient details including a phone number to allow the surgical admission unit to contact the patient when a bed becomes available.   

If the patient is clinically unable to wait for a bed, the urology registrar will arrange for the patient to be brought to the emergency department and inform the ED staff that the patient is accepted by urology.

If the urology registrar is not able to answer the GP call at that time, the HUB will take the details of the patient, clinical problem and the referring GP name and number. The HUB will then contact the urology registrar, requesting they re-discuss with the GP if there are concerns about the referral.

Please ensure a letter accompanies the patient to hospital.