Cystoscopy:75 years on

Urology DirectorateCystoscopy GRS ProjectIntroductionFlexible cystoscopy is the core urological diagnostic procedure. In Scotland this comprises 56% of the day case workload and 28% of the total urological workload.

We have successfully reduced the waiting time through the development of agreed referral pathways, nurse-led / same day vetting and straight to test booking. However the issues surrounding the quality and safety of the patient-centred procedure have not yet been examined.

AimThe aim of the project is to develop a quality assessment tool to measure the performance of cystoscopy units in achieving the six dimensions of quality as outlined in ‘Better Health, Better Care’(2007); namely patient centred, safe, effective, equitable and efficient care.

The Global Rating Scale (GRS) has been used in Scotland within endoscopy units to assess quality of care. This tool will be adapted for flexible/GA cystoscopy to establish a national reporting system, creating a national standard for flexible cystoscopy.

ToolsIn conjunction withtailored software we can standardise the information to ensureconsistent datarecording, monitorprocedure completionrate and generate immediate results for patients and clinicians. The use of regular patient feedback surveys will allow benchmarking of services and enable us to identify potential improvements in efficiency on an ongoing basis.

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Urology DirectorateCystoscopy GRS Project

Flexibility of Project

Cystoscopy nurse left post

Alternative software productEnhanced utilityQuarter of cost

Flexible cystoscopy:the challengeHighest incident procedure in urology

Diagnostic and surveillance utility

CCI:the process• Analysis-understanding the patient journey• Understanding the system-

demand ,capacity ,activity and backlog• Measurement• Queueing theory

CCI Project :the result

9 week wait• Improved referral

pathways• One stop clinics• Pooling of waiting lists• Increased flexibility of

working • Increase in capacity

Teamwork

Better Health Better Care Action Plan: 6 Dimensions of Quality• Timeliness• Patient centred • Safe• Effectiveness• Equitable• Efficient

Flexible cystoscopy and the Global Rating Scale(GRS)• How many flexible cystoscopies per annum/

per consultant in Scotland?

• Which guidelines do you use? BAUS EAU AUA• What evidence can you produce for

revalidation/recertification about quality/outcome of your flexible cystoscopies?

Endoscopy Global Rating ScaleNational census twice yearly (April and October)

• Following a pilot in September 2004 six national censuses have been held at six month intervals

• The GRS is now used as the quality standard for JAG and bowel screening accreditation visits

www.grs.nhs.uk

What has the GRS achieved?

www.grs.nhs.uk

10/06

10/05

04/07% scoring A or B

GRS – National resultsGRS – National resultsone item -one item - six censuses over 2.5 years (207 units)six censuses over 2.5 years (207 units)

04/05

04/06

10/0610/05

04/07

level B or better is the current standard for an acceptable service

10/07

D C B A

1 2 3 4 5 6+ 12 patient centred items

Each item has four levels A-D (descriptors)

Each level is underpinned with 1-5 measures

1 2 3

Endoscopy Global Rating ScaleThe patient experience

2 dimensions: clinical quality & quality of thepatient experience

1 2P

www.grs.nhs.uk

Summary Allow us to address the

quality dimensions

Provide an audit tool

Improve the quality and safety of flexible cystoscopy