Drudge-Coates Lawrence, Khati Vitra, Ballesteros Randolph, Martyn-Hemphill Clarissa, Brown Christian, Green James, Challacombe Ben, Muir Gordon
Department of Urology, King's College Hospital NHS Foundation Trust, SE5 9RS London, UK.
Department of Urology, Barts Health NHS Trust, London EC1A 7BE, UK.
Ecancermedicalscience. 2019 Dec 18;13:994. doi: 10.3332/ecancer.2019.994. eCollection 2019.
To evaluate the outcomes from a Urology Nurse Practitioner (UNP)-led service for the initial assessment and diagnostic decision making and for suspected prostate cancer referrals.
Using a modified Delphi analysis approach, a panel of Urological Prostate Cancer specialists were asked to review the UNP management plans of a convenience sample of 60 randomly selected patient cases - between June 2012 and June 2015. The panel was required to establish consensus or identify divergence of clinical practice, based on five key statements. In addition, cost analysis, waiting time and patient satisfaction evaluation were made regarding the nurse-led service.
In 87% (52/60 cases), consensus was reached by the panel that the UNP management plan was entirely appropriate and in only two cases was there discordance, where the panel felt that the management plan by the UNP was inappropriate with errors potentially and significantly affecting the patient. Over the 3 years, a modest cost saving of £11,500.38 was realised, which due to increased referrals has now realised in 1 year (2017/18) a saving of £11,335.50. Compared to the previous physician-led service, waiting times for patient appointment fell by 52% over the 3-year period; 57/63 (90%) patients reported being satisfied with seeing a UNP instead of a doctor for their first appointment; 60/63 (95%) reported that, following the initial hospital visit with the UNP, they had a clear understanding of what the next steps were in their assessment. Overall, 54/63 (86%) were 'very satisfied' with the UNP-led service.
Our study demonstrates that a UNP approach to the assessment and management of suspected prostate cancer referrals provides an effective approach to care in an ever-demanding healthcare arena.Through a supported training programme, urology nurses can deliver a high standard of service.
评估由泌尿外科执业护士（UNP）主导的服务在前列腺癌疑似病例的初步评估、诊断决策及转诊方面的效果。
采用改良的德尔菲分析方法，邀请一组泌尿外科前列腺癌专家审查2012年6月至2015年6月期间随机选取的60例患者的便利样本的UNP管理计划。要求该小组根据五项关键陈述达成临床实践的共识或确定分歧。此外，还对护士主导的服务进行了成本分析、等待时间和患者满意度评估。
87%（52/60例）的病例中，专家小组达成共识，认为UNP管理计划完全合适，只有两例存在分歧，专家小组认为UNP的管理计划不合适，存在潜在错误且可能对患者产生重大影响。在这三年中，实现了适度的成本节约，为11,500.38英镑，由于转诊增加，现在（2017/18年）一年就实现了11,335.50英镑的节约。与之前由医生主导的服务相比，患者预约的等待时间在三年期间下降了52%；63例中有57例（90%）患者表示对首次就诊时由UNP而非医生看诊感到满意；63例中有60例（95%）表示，在首次到医院由UNP就诊后，他们清楚地了解了评估的下一步步骤。总体而言，63例中有54例（86%）对UNP主导的服务“非常满意”。
我们的研究表明，在对前列腺癌疑似转诊病例的评估和管理中，UNP模式在需求不断增加的医疗保健领域提供了一种有效的护理方法。通过支持性培训计划，泌尿外科护士可以提供高标准的服务。
