Page 111 - Hospital Authority Convention 2017

Parallel Sessions

PS1.4 Nursing Services at the Front Door of the Hospital 13:15 Room 221

Ambulatory Management of Try off Urethral Catheter – Patient Discharged from AED and Ward
Tang KCC
Department of Surgery, Kwong Wah Hospital, Hong Kong HOSPITAL AUTHORITY CONVENTION 2017
Introduction
Acute retention of urine (AROU) is defined as an involuntarily voiding and sense of painful in suprapubic area. Most of the
male patients who suffer from AROU are associated with benign prostatic hyperplasia (BPH). AROU is very common in elder
patients. Traditionally, patients will need to be treated as inpatient until success trial of wean off catheter (TWOC). For those
patients who failed TWOC, urethral catheter needs to be reinserted and readmit to urology ward for trial TWOC again.

In order to reduce the unnecessary hospitalisation and unplanned readmission, an Ambulatory Try off Catheter (ATOC)
programme is implemented by the cooperation between the Surgery and Emergency Department. The current conventional
inpatient care will be tried to transform into outpatient care service.
Objectives
(1) To develop a protocol and care pathway on ATOC programme in outpatient setting; and (2) to reduce unnecessary
admission.
Methodology
Male patients who suffered from urinary retention and admitted to Kwong Wah Hospital with symptoms relief after inserted
urethral catheter were recruited. Patients were assessed by physician in Emergency Department, and then referred to ATOC
programme in Urology Centre if the inclusion criteria of ATOC pathway were fulfilled. The urology nurse would provide
a comprehensive assessment, high-quality urological nursing care and intervention according to the ATOC pathway in Tuesday, 16 May
outpatient setting.
Results
The ATOC programme was implemented from September 2016 to December 2016 with a total of 81 male patients presented
to the Emergency Department with AROU. 31 male patients were admitted as the inclusion criteria were not fulfilled. The
remaining 55 male patients were recruited to the ATOC programme according to the pathway. This programme reduced the
admission rate with AROU by 63.9%. The mean age of these ambulatory care patients was 73.8 ± 9.8years (range from 42 to
103 years old). The successful rate of wean off catheter in ATOC programme was 62% (34 patients), there were six unplanned
admissions (12%) within 30 days; four of them developed AROU again, one patient admitted due to haematuria and one
patient admitted due to depression. 16 patients (296%) failed to wean off catheter in ATOC programme. All patients were
counseled for urethral catheter reinsertion versus clean intermittent self-catheterisation (CISC). Only two patients succeeded
to learn CISC, the remaining 13 patients needed to reinsert the urethral catheter. A total of 55 patients’ beds were saved and
it could reduce the front-line workload and relieved the bed shortage in surgical ward.

Conclusion
The ATOC programme in outpatient setting is effective and safe for patients presented with AROU. It can reduce hospital
admission rate and relieve bed shortage in the surgical ward.

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