Implementation of a multidisciplinary hospital and community acute urinary retention pathway for emergency department patients

Acute urinary retention (AUR) is a common urological emergency in older men and can be a frightening experience for patients. Optimal patient centered care requires that these patients get a urinary catheter placed in a timely manner in the emergency department and early follow up in the Trial Without Catheter clinic in the urology department. Referral to the community intervention team and public health nurse to ensure patients can access catheter care in the community if required is vital. The global aim of this cross hospital specialty and community team was to use multicomponent interventions wto improve the management for male patients presenting with AUR. In the ‘plan’ phase, we set out our five Specific, Measurable, Actionable, Realistic and Timely (SMART) measures, two outcome measures: (1) reduction of Patient Experience Time in the emergency Department (2) Reduction in time to follow up in the Urology Trial of Voiding Clinic Patients suitable for the pathway were patients presenting with AUR and did not have evidence of sepsis, visible haematuria, acute kidney injury, residual volume >1000mls or recent urology surgery. After baseline data collection, we introduced the AUR pathway proforma, patient information leaflet and a standardised urinary catheter equipment discharge prescription and a simplified referral pathway for ED patients to be directly referred to the TWOC clinic. We delivered focused sessions of AUR education for ED staff. The ED nursing clinical facilitator championed referrals to the public health nurse and ensuring that patients leave with a discharge catheter pack. The Community Intervention Team (CIT) liaison clinical nurse manager championed referrals to the local CIT. We collected data following the interventions. 35 patients with an ED discharge diagnosis of AUR was identified in the first study period (March to April 2023) and 10 patients were identified in the second (May to June 2023) Following our PDSA cycle, there was a compliance rate of 70% in the post-intervention group for use of the AUR pathway proforma. The audit demonstrated improved mean ED Patient Experience Times (8.1 versus 5.6 hours, p<0.05). There was a reduction in time to follow up in the TWOC clinic (31 days to 29 days). There was no statistical difference observed in the re-attendance rates (27% v 30%, p>0.05). A multidisciplinary multicomponent pathway improved patient centered outcomes for emergency department male patients presenting with AUR.