Julie Cornish, Consultant Colorectal Surgeon
Louise Silva, Colorectal Research Fellow
Cardiff and Vale University Health Board
Patient Journey App
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 often means that care can be disjointed and compartmentalised. These difficulties have been well publicised, in the wake of the mesh scandal; the recent Cumberlege report has stressed the need to integrate existing pelvic health services into specialist centres, to act as “one stop shop”.
Consolidate existing pelvic health services (colorectal, gynaecology, urology) into a community hub
Develop a supporting Patient App
· Maximise the availability of conservative treatments for pelvic health dysfunction
· Increase patient compliance of conservative treatments
· Strengthen working relationships and skills within our multi-disciplinary team
· Streamline the patient pathway
· Reduce the need for surgery
The OMNIUM Project
Our team consists of:
community continence nurses
pelvic health co-ordinators
commercial team members including Medtronic and Patient Journey App
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.
How do the Hub and App work?
Once red flag symptoms have been excluded by the referrer, patients are asked to download the App and asked a series of questions. Patients are then triaged to the most suitable professional for initial face-to-face assessment. In the meantime, the App records baseline PROMs, signposts to additional support services, and provides education on conservative treatment.
Following initial face-to-face assessment at the hub, a patient specific 12 week conservative programme is added to the app. This supports the information provided in the face-to-face consultation, and provides reminders to ensure patient compliance, alongside ongoing education. Patients are asked to repeat PROMS at the end of the 12 week programme. Patients who have had a significant improvement will be discharged from the service.
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.
88% of patients with pelvic health complaints can be managed by conservative treatment. Our previous conservative treatments have been disjointed - taking over 10 years to complete treatment!
CAVUHB is the only health board, within Wales, to have developed a service in response to the recommendations of the Cumberlege report, and Welsh Task and Finish Groups for mesh and faecal incontinence.
The biggest difficulty we had was confirming a location site for the hub. The second wave of the pandemic brought uncertainty as to whether we would be able to secure an existing NHS site, or whether we needed to explore commercial options. This meant a modest delay to our implementation timescale.
We needed to change the initial provider of our App Provider due to licencing agreements of PROMS tools. This was early on in the project so had minimal effect, and meant we were able to co-develop our existing App to fully align with our service.
This is a large scale collaborative project, covering multiple specialities and directorates. We have always had universal “buy-in”, but with such a large project came the expected difficulties of ensuring the consistent attendance of clinical members at meetings. This challenge was heightened during the pandemic. However, meetings still occurred on a regular basis and a conscious decision was made not to postpone the project until after the pandemic. Absentees were informed of key developments to ensure ongoing engagement.
Community Pelvic Health Hub site confirmed for Barry Hospital (6 rooms) with 5 sessions a week
1st Clinic confirmed for 7th June 2021
New additional conservative treatment options provided - Posterior tibial nerve stimulation for colorectal patients completed 12 week cycle (May 2021)
App finalised for Referral Pathway and Faecal Incontinent Pathway with Patient Journey App (May 2021)
All members of staff remain fully engaged in the service
Additional dietician support confirmed for 2 sessions a week
Unexpected additional “buy in” from community continence nursing staff who will be joining our service
Supported by the Welsh Health Implementation Group and MASIC Charity
This is a pilot service. If the pilot proves successful, it is anticipated that additional sessions will be required, either at Barry Hospital or potential relocation.
We are including a rectal bleeding clinic and increasing capacity to perform minor procedures, such as banding and some sacral nerve stimulation procedures (under local anaesthetic).
We plan to transition more of our diagnostic services, such as endo-anal ultrasound, anal manometry, cystoscopy and sigmoidoscopy in the 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.