Julie Cornish and Louise Silva
Cardiff and Vale University Health Board with Medtronic Interactive Studios
Background:
Pelvic health services provide care for all patients who suffer with functional pelvic issues (including bladder and bowel incontinence, constipation, pain and prolapse). Pelvic health services cross-cover the surgical disciplines of colorectal surgery, urology and gynaecology and primary care.
This overlap means care can be sometimes disjointed and inefficient. There has been a national drive, as a result of the Cumberlege report, to create pelvic health “one stop shops”.
Project Objectives:
- Consolidate existing pelvic health services (colorectal, gynaecology, urology) into a community hub
- Develop a supporting Patient App
Aims:
- Maximise the availability of conservative treatments for pelvic health dysfunction
- Increase patient compliance of conservative treatments
- Expand our multi-disciplinary team skillset and working relationships.
- Streamline the patient pathway
- Reduce the need for surgery
Who’s involved?
Our team consists of:
- Colorectal Surgeons
- Gynaecologists
- Urologists
- Physiotherapists
- Nurse Specialists
- Dieticians
- Counsellors
- Pain Specialists
- Community Continence Nurses
- Pelvic Health Co-ordinators
- Healthcare Managers
- Commercial team members including Medtronic and Interactive Studios
What happens at the hub?
The hub is located at Barry Hospital. We provide:
- Consultations with all of our members of staff. Some of our consultations are joint with multiple specialities, reducing delays and improving communication.
- Conservative treatment such as lifestyle and medication review, physiotherapy, counselling, education and bio-feedback
- Minor procedures such as posterior tibial nerve stimulation (PTNS)
- Diagnostics. We aim to expand by transitioning our existing investigations such as anal manometry, endo-anal ultrasound and cystoscopy to the hub in the near future.
Why was it needed?
“It took a long time to get to the right person…I feel like I went round the houses.”
“I have seen so many different people ….It was frustrating….I had to go through everything again….”Patients’ experience of our previous services before the OMNIUM Project
Challenges:
- Confirming a site location – whether this would be an existing NHS site or third party, resulting in a modest delay to implementation.
- Changes to App supplier early on in the project due to PROMS licensing agreement. This happened early on in the project, so enabled us to co-develop our app in order to fully align with our service.
Key Outcomes:
- 1st Clinic at the hub confirmed for 7th June 2021
- New PTNS service now offered for colorectal patients.
- App finalised for Referral Pathway and Faecal Incontinent Pathway with Patient Journey App (June 2021)
- Additional dietician support confirmed for 2 sessions a week (pilot)
- Funding secured for additional staff: pelvic health physiotherapist, pelvic health coordinator and colorectal nurse specialist.
- Additional “buy in” from community continence nursing staff who will be joining our service
- Supported by the Welsh Health Implementation Group and MASIC Charity
Next Steps:
- We are including a rectal bleeding clinic and increasing capacity to perform minor procedures, such as haemorrhoid banding and some sacral nerve stimulation (SNS) procedures (under local anaesthetic).
- We plan to transition more of our diagnostic services, such as endo-anal ultrasound, anal manometry and cystoscopy in the near future.
- The App is further being developed for other pelvic dysfunction complaints, including urinary incontinence, chronic constipation and low anterior resection syndrome (LARS).
- The aim is to become a service model for all patients with pelvic health dysfunction.
- This could be applied to an all Wales or national level.
