Urgent Care and Admissions (Urology) - under review

Overview

Urology services in BNSSG are provided by NBT, GP Care and Independent Sector Providers.

• GP Care accept both routine and urgent referrals via eRS and also provide the Urology Advice and Guidance service (response normally within 5 working days). They can manage most urology referrals (but not kidney stones) but do not provide an emergency/acute service.
• NBT provide the secondary care urology service and appropriate referrals will be forwarded via GP Care.  They also provide urgent (same day) advice and admission where necessary (see below)
• Independent Sector Providers (e.g. Practice Plus Group (formerly Emersons Green Treatment Centre) and Sulis Bath) also accept referrals via eRS for a variety of urology conditions but do not provide an emergency/acute service.
• Community Services (Sirona) - community nurses can also provide care where appropriate. See the  Bladder & Bowel Services page for details.

Emergency/ Acute Service - NBT

The NBT urology on-call registrar manages a high volume of responsibilities, including an extremely high number of phone consultations with GPs, district nurses, and other specialties, while also caring for the hospital's most critical urology patients and handling emergency surgeries. Due to the increased amount of phone calls, the line is often busy. To ensure efficient care, please contact the urology team only for urgent issues that cannot wait. For all other urological problems, please consider the options above.

NBT aims to assess emergency urology patients in the surgical admission ward (32b) or the Surgical Same Day Emergency Care (SDEC) unit at Gate 36, rather than the emergency department. For details on arranging an admission or referring to the Urology SDEC, see the guidance below. 

Suspected Renal Colic

Please see the Renal Calculi page. Suspected renal colic can be referred to SDEC if patient is stable and AAA is not suspected. Think AAA - 10% of AAAs present as renal colic and may involve haematuria  due to renal artery involvement. Admit as emergency or contact vascular on call team if in doubt.

Same day Advice

Contact the On-Call Urology Registrar (or surgical hospital at night team between midnight and 0600) at NBT via Southmead Hospital switchboard for urgent urological advice or potential admissions. 

Important: The urology team is very busy, so only contact them for urgent issues that cannot wait. For less immediate concerns please consider using  the Urology Advice and Guidance service. 

Please note that difficult catheter changes are no longer seen by the Urology Team in the first instance. Please contact the SDEC Team directly if the patient meets the SDEC criteria stated below. For further information on difficult catheter changes please see the Difficult Catheter Changes page for advice and local pathways - confirmation of this pathway to be confirmed (17.9.24) 

Conditions suitable for Same-Day Advice/Assessment: 

• Acute urinary retention (if primary care cannot catheterize the patient)
• Renal colic (only for patients with typical symptoms and positive urine dip for haematuria or frank haematuria)
• Ureteric stent, nephrostomy, or urostomy complications
• Recent urology surgery complications (< 4 weeks)
• Urological cancers with complications
• Known ureteric stones with worsened symptoms

Urology SDEC

The Urology SDEC Clinics at NBT and WGH are designed for emergency ambulatory adult patients to avoid unnecessary hospital admissions. It is an admission avoidance clinic; it is generally not to bring patients back for review after a previous admission or for chronic problems. 

How to refer - NBT

If you suspect a patient needs to be reviewed in the surgical day assessment unit and is unlikely to need admission, please contact the Urology Registrar on-call at NBT via switchboard. The Urology SDEC booking is made only by the urology registrar on call.   No other teams can send patients to the urology SDEC. 

SDEC Operating Hours: 0800 - 1700 (Gate 36 closes at 1900), 7 days a week. The clinic does not accept new patients for same-day review beyond 1700.

Please call the switchboard to reach the Urology registrar via NBT switch: 0117 9505050 

How to refer - WGH

For North Somerset patients there is an SDEC at Weston operating from from 8am until 8pm, but urology are only available Monday to Friday and not onsite after 5pm. Therefore they generally do not accept patients after 4pm to give time for the registrars to assess and manage the patients. 

To access the referrer should contact the urology reg on call (bleep 090) via switchboard.

Referral criteria

To be suitable for SDEC all of the criteria below should be met:

• Age 16 years and older.
• Referred between 0800 – 1700 (as Gate 36 closes 19:00) 
• Patient able to attend G36 with assistance (not bed-bound) 
• NEWS2 score of 3 or below 
• Patient orientated and cooperative 
• Patient seems likely to go home after review

Exclusions:

• Suspected testicular torsion - all patients with this condition need to be referred to the Emergency Department (ED) where Urology will review these patients promptly. Please see the Scrotal Swellings & Testicular Lumps & Pain page.  
• Possible sepsis or NEWS2 score of 4 or above. Refer to local ED.
• Suspected renal colic where Abdominal Aortic Aneurysm is a possibility. Refer to local ED.
• Admission is likely (see Admissions section below).

Further information about the Urology SDEC 

• There are shared rooms with other surgical specialties. SDEC operates 7 days a week.
• There are limited planned US slots (especially at the weekend) and access to urgent CT scans, when appropriate. The Urology on-call team will request and arrange the ultrasound/CT scan for the patient.
• SDEC patients do not take priority over inpatient work so will be subject to delay at times of peak inpatient and ED activity. 
• Due to the significantly increased number of patients seen in SDEC, the waiting times can be over 6 hours. Please advise the patients on the possibility of long waiting times.  

Urology Admissions

If you suspect a patient needs admission please call the switchboard at NBT:  0117 9505050 

The switchboard 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. 

Please ensure a letter accompanies the patient to hospital. 

Please note that UHBW do not offer a Urology service. 

Catheter Problems

A pathway has been introduced for patients experiencing catheter issues to ensure faster care while maintaining appropriate treatment. Patients will now be seen in either the Emergency Department or, if eligible, at the Same Day Emergency Care (SDEC) service in NBT.

Criteria-led discharge has been established for catheter-related cases. If certain conditions are met, and no other concerns arise, patients will be discharged:

If residual urine exceeds 1000 ml, the case will be discussed with the Urology Team.

SDEC Service

Criteria

• Not bed-bound
• NEWS 3 or below
• Orientated and cooperative
• Likely to be discharged after review

Patients can be referred directly to the SDEC Team if eligible by calling 0117 414 9190 between 08:00 and 17:00.

A qualified nurse specialist will assess patients with blocked or displaced catheters in SDEC between 08:00 and 17:00 (Surgical SDEC Gate 36 closes at 19:00).

Urology On-Call Notification: The Urology On-Call Team does not need to be notified, as these patients are no longer seen by the Urology Team.

Emergency Department

Patients who do not meet criteria for SDEC should be referred to ED.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.