Authors (including presenting author) :
Yung WY, Chiu FS, Leung SY, Tsang JWM, Chan MY, Wan LH, Wong LY, Lu GYK, Lau VSH, Chan KK, Chan SC, Tsui YS, Ho WY, Ling YM, Ho FY, Chun W K, Chan M K, Chung CM, Ma KC, Cheng CH, Chan YS, Li KM, Man CW, Chu SK
Affiliation :
(1) Combined Urology & Vascular Unit, Tuen Mun Hospital, (2) Day Urology Services, Pok Oi Hospital, New Territories West Cluster
Introduction :
Haematuria is one of the indicators for urinary tract malignancy, particularly bladder cancer. Its presentation exhibited in benign urological conditions such as urinary tract infection (UTI) or urinary calculi are often similar. Integrated Model of Specialist Out-patient (SOP) Service was being adopted into Haematuria Nurse Assessment Clinic (HNAC) since December 2023 in NTWC (see attachment)
Objectives :
HNAC aims at effectively prioritize patients who suffered from haematuria by carrying out investigations and interventions by trained Urology Nurses with guidance of pre-approved protocol and to report the clinical outcomes of HNAC service among 564 patients. Prompt treatment or advises can be delivered by early diagnosis of potentially life-threatening conditions/malignancy during triage process preventing complications aroused.
Methodology :
324(57%) male and 240(43%) female with mean(range) age was 64.56 years old (14-93)(table 1). Average waiting time for initial assessment was 15.68(1-92 days). 104/564(18%) population were found to have abnormal USG screening with suspicious of: bladder mass(18), bladder stone(12), renal stone(45), hydronephrosis(29)(table 2). Of 18 suspicious of bladder mass from USG, 9(50%) confirmed bladder malignancy. 87/564(15.4%) with positive urine cytology results while only 9(10.3%) had been diagnosed bladder cancer. 450/564 followed up at ACC with 295/450 undergone FC. 23(7.8%) of 295 diagnosed malignancies with 17(74%) bladder tumor, 1(4.3%) renal cell carcinoma, 2(8.7%) prostate cancer, 1 (4.3%) ureter tumor,1(4.3%) penis tumor,1(4.3%) cervix tumor. Average waiting time from HNAC to ACC follow up was 112 days(4-813). 42/564(7%) were given medical appointment < 1month; Average waiting time from HNAC to FC was 170 days. 97-98% patients were satisfied with service provided (table3).
Result & Outcome :
All urology new case referrals were screened by Urologists. Patients with haematuria were referred to HNACs located at Day Urology Centre of TMH & POH before their first medical consultation. Attendances will be arranged for carrying out preliminary clinical assessment, investigations and related interventions by Urology Nurses. All investigation reports were screened by Urologists and medical appointment was granted accordingly. A retrospective, two centers (TMH & POH), review of 564 patients with haematuria managed by Urology Nurses in HNAC between 28 Dec 2023 and 30 Nov 2024 were included for analysis from database. In Nov 2024, patients were invited to carry out questionnaire, over one months, to evaluate patient experiences and satisfaction towards HNAC. The questionnaire was designed to assess patient satisfaction with self-empowerment enhancement, interactions with nurses, waiting times and explanations.
The redesigned HNACs lead by Urology Nurses demonstrate crucial rules which effectively prioritize patients who suffered from haematuria. Prompt treatment or advises can be delivered by early diagnosis of potentially life-threatening conditions/malignancy during triage process preventing complications aroused.
