The Pelvic Health Community Hub
Julie Cornish, Consultant Colorectal Surgeon, University Hospital of Wales
Louise Silva, Colorectal Research Fellow, University Hospital of Wales
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”
Patients’ experience of our previous services before the OMNIUM Project
“I have seen so many different people ….It was frustrating….I had to go through everything again….”
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.