The one-stop clinic as the standard of out-patient care in a hospital urology department

PURPOSE: To evaluate the performance of a 'one-stop' clinic in terms of proportion of discharges or inclusion in surgical waiting lists. MATERIALS AND METHODS: All patients were referred from primary care facilities (population 220.646) and from different departments in the hospital. Eight senior urologists, two registered nurses and two nurse attendants participated in the experience. Prior to the start of the project, referral protocols had been agreed with the primary care physicians involved. Compliance with the protocols was periodically tested. Eventually 5537 first visits (January-December 2009) where evaluable. RESULTS: Overall, the 'one-stop' format proved feasible in 74.2 percent of the patients (4108/5537). Patients, who successfully used the 'one-stop' format, were significantly younger than those who required additional consultations (43 vs 50 years old, respectively, Student's t test < 0.001). For obvious reasons the 'one-stop' format was universally possible in male sterilization and penile phimosis patients. Similarly, the 'one-stop' policy was applied in most consultations due to male sexual dysfunction (75 percent) and urinary tract infection (73 percent). Other health problems, such as haematuria (62 percent) and renal colic (46 percent), required more than one visit so that care of the patient reverted to the traditional, outpatient care model. CONCLUSION: A 'one-stop' philosophy is feasible for a number of procedures in a urological outpatient clinic. The costs to implement such an approach would be limited to managerial expenditure.

Adverse events and readmissions after day-case urological surgery

OBJECTIVE: The literature lacks of studies on postoperative outcomes after urological ambulatory surgery. Our study aims to identify parameters associated with postoperative complications within 30 days after ambulatory urological surgery. MATERIALS AND METHODS: Adjusted and unadjusted comparisons between clinical features and postoperative outcome (complicated and uncomplicated). RESULTS: Postoperative course was complicated in 5 percent of the patients. Discharge schedule was not completed in 1.1 percent while unplanned visits resulted in admission in 0.5 percent. Multivariate analyses could only confirm the independent effect of type of anesthesia and diagnosis-related group (DRG) relative weight. CONCLUSIONS: Ambulatory urological surgery can be safe in terms of postoperative complications. In the present study surgery under general anesthesia, or a higher DRG relative weight procedure, increased the risk of complications compared to surgery under regional or local anesthesia or lower DRG relative weight operations. Patients scheduled for general anesthesia or undergoing complex urological procedures should be warned about an increased risk of postoperative incidents and/or readmission.