Urology challenges

There is notable variation in NHS patient pathways for common urological procedures like transurethral resection of prostate (TURP) and bladder tumour (TURBT). Amid capacity issues heightened by COVID-19, longer wait times, especially for benign procedures, are a concern.

Streamlining these pathways into day-case procedures could improve efficiency, as suggested by professional bodies, the UK Department of Health, and the 2018 Getting it Right First Time (GIRFT) report1. This change may also maintain care quality while addressing standardisation needs.

Reduced waiting lists

It can reduce waiting lists by increasing throughput and reducing hospital stay times.

Improved theatre efficiency

It can improve theatre efficiency by maximising surgical throughput and reducing turnaround times.

Increased inpatient beds

It can release inpatient beds by minimising hospital stay.

Decreased cancellations

It can decrease cancellations by reducing dependency on inpatient bed availability.

Improved patient experience

It can improve patient experience by reducing hospital stay duration.

Cheltenham General Hospital Case Study


Cheltenham General Hospital faced a challenge in 2019. They needed to free up inpatient beds and reduce the number of readmissions while increasing the number of urology patients treated within 18 weeks of referral.2

The hospital introduced a technology called PLASMA+, which has received a recommendation from NICE and is covered by the MedTech funding mandate. 3,4

It’s a bipolar resection device from Olympus that can be used to remove prostate tissue and non-muscle invasive bladder cancer.

PLASMA+ was introduced as part of a new day-case pathway for eligible patients to receive treatment and go home the same day, replacing the existing inpatient pathway and the monopolar device.

PLASMA+ is now an NHS Supply Chain Value-Based Procurement case study, which can be accessed in full here >

Cheltenham General Hospital Case Study

Watch Jeremy Nettleton, Consultant Urologist and Clinical Lead at Cheltenham General Hospital, discuss the reasons behind the hospital's changes and their positive impact.

Case Study Results

The urology unit at Cheltenham General Hospital performed 313 procedures to treat enlarged prostates, all using PLASMA+

The introduction of a day-case pathway, including PLASMA+, replacing the inpatient pathway and previous monopolar device led to a notable reduction in the average length of hospital stays—1.8 days less for enlarged prostate procedures.7 As a result, 563 more inpatient bed days were made available from April 2021 to March 2022, generating significant cost savings: approximately £152k for enlarged prostate procedures.8

*mTURP: Monopolar Transurethral Resection of the Prostate

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Case Study Results (Continued)

The urology unit at Cheltenham General Hospital performed 320 procedures to treat NMIBC, all using PLASMA+.

The introduction of a day-case pathway, including PLASMA+, replacing the inpatient pathway and previous monopolar device led to a notable reduction in the average length of hospital stays—1 day9 less for NMIBC** procedures. As a result, 307 more inpatient bed days were released from April 2021 to March 2022, generating significant cost savings: approximately £77k for NMIBC** procedures. 8

*mTURBT: Monopolar Transurethral Resection of Bladder Tumour
**NMIBC: Non-Muscle Invasive Bladder Cancer

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Case Study Results (Continued)

The introduction of a day-case pathway, including PLASMA+, replacing the inpatient pathway and previous monopolar device, led to increased day-case rates, reduced hospital stay, and decreased readmission rates.

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Overall

Overall, the implementation of a new day-case pathway, including PLASMA+ from November 2021 to October 2022 led to savings and increased bed availability, resulting in a total saving of £230k10

Download the full case study now

Healthcare Conversations

Helena Burden, Consultant Urological Surgeon at North Bristol NHS Trust, discusses the importance of Pathway Transformation and the best ways of delivering this in healthcare.

Our Most Advanced Energy System Yet: PLASMA+

PLASMA+ could be beneficial for a day-case pathway since it reduces bleeding and shortens hospital stay. If you want to learn more about PLASMA+, you can check it out here.

Learn more >

1. Harrison S. GIRFT Programme National Specialty Report; Urology. GIRFT July 2018
2. NHS England. (2024). The Model Health System. Retrieved January 23, 2023, from https://model.nhs.uk
3. www.nice.org.uk. (n.d.). Overview | The PLASMA system for transurethral resection and haemostasis of the prostate | Guidance | NICE. [online] Available at:
https://www.nice.org.uk/guidance/mtg53
4. www.england.nhs.uk. (n.d.). NHS England» MedTech Funding Mandate policy 2022/23: guidance for NHS commissioners and providers of NHS-funded care. [online] Available at: https://www.england.nhs.uk/publication/medtech-funding-mandate-policy-2022-23-guidance-for-nhs-commissioners-and-providers-of-nhs-funded-care
5. This statistic refers to all patients in the urology department, not just those waiting for mTURP or mTURBT procedures.
6. NHS England. (2024). The Model Health System. Retrieved January 23, 2023, from https://model.nhs.uk
7.The average length of stay decreased from 2.2 days (April 2018 to March 2019) to 0.4 days (November 2021 to October 2022), a reduction of 1.8 days, after transitioning from an inpatient to a day-case pathway and replacing mTURP with PLASMA+.
8. Getting It Right First Time (GIRFT). (2024). National Consultant Information Programme (NCIP). GIRFT. Retrieved January 23, 2023, from https://nhsi.okta-emea.com
9.The average length of stay decreased from 1.3 days (April 2018 to March 2019) to 0.3 days (November 2021 to October 2022), a reduction of 1 day, after transitioning from an inpatient to a day-case pathway and replacing mTURBT with PLASMA+.
10. The study shows that using PLASMA+ instead of mTURP saves £485 per patient, and £243 per patient instead of mTURBT. Between November 2021 and October 2022, 313 patients were treated with PLASMA+ instead of mTURP, saving £151,785, and 320 patients instead of mTURBT, saving £77,788, for a total savings of £229,573.