Authors (including presenting author) :
KWOK SW(1), HO KW(1), NGAN TK(1), AU WK(1), TANG WY(1), TSOI CH(1), KAM WS(1), LEUNG WY(1), YUEN KL(1), Lee LN(1), YEE CH(2), NG CF(2)
Affiliation :
(1)Lithotripsy and Uro-investigatoion Centre,Department of Surgery, PWH, (2)SH HO Urology Centre, Department of Surgery, The Chinese University of Hong Kong
Introduction :
Prostate cancer is the third most common cancer among men in Hong Kong. Robot-assisted laparoscopic radical prostatectomy (RALP) is the standard surgical treatment. Conventionally, patients will be admitted on post-operative Day 7 (or later according to individual surgeon’s discretion) for trial without catheter (TWOC). While this admission is in the format of day-admission, in-patient care is still needed from house officers and urology surgeons for patient assessment upon admission and discharge. Since the TWOC process in this group of patients is mostly uncomplicated and they would require continence care counselling as well after surgery, PWH Lithotripsy and Uro-investigation Centre (LUC) of NTEC has started an initiative to combine all of these procedures into a single nurse-led out-patient clinic attendance. This “one-stop post-prostatectomy TWOC and continence care urology nursing service programme” aims to streamline the post-operative follow-up for RALP patients and to improve the efficiency of care delivery.
Objectives :
The PWH LUC “one-stop post-prostatectomy TWOC and continence care urology nursing service programme” was set up to enhance the convenience of patient flow and to optimize the use of nursing and medical staff. Here we are reporting the efficacy and outcome of the programme.
Methodology :
The “one-stop post-prostatectomy TWOC and continence care urology nursing service programme" was started in Jan 2021 and this involved all patients after RALP in NTEC. On the designated day of TWOC all RALP patients were scheduled to have a nurse clinic appointment instead of an in-patient admission. During clinic attendance, patients were offered clinical assessment, TWOC procedure, post-operative care counseling and continence education, as well as a post-TWOC follow-up plan. As the patients were managed as out-patients in the programme, TWOC procedure was done in an ambulatory setting. If post-operative complication was noted which required an urologist’s input, on-call urologist would attend the patient and provide the appropriate management. The service model is endorsed by nurse consultant and consultant urologist of NTEC.
Result & Outcome :
In the period from January 2021 to December 2023, 206 patients had undergone RALP in NTEC. All of these patients were referred to the “one-stop post-prostatectomy TWOC and continence care urology nursing service programme” and nurse-led TWOC clinic was arranged on post-op Day 7-10. In our cohort, all patients were successfully managed in an out-patient setting and no patients required admission for further in-patient care. TWOC procedures were completed in an ambulatory manner without complications. Besides post-operative care counseling and continence education, nursing care for wound complications avoided additional patient attendance to GOPD or A&E department. In conclusion, with this one-stop nurse clinic programme the conventional day case admission after RALP can be obviated. Patients are empowered in their early post-operative period through nurse counseling and education.
