Patients with bladder and pelvic floor issues often require specialized testing and multidisciplinary care involving a variety of providers, including gynecologists, urologists, family physicians, nurses, and physiotherapists. However, the provision of these services can be disjointed and the wait times prohibitively long. Patients dealing with incontinence could sometimes wait 6 months for a referral, another 2 years for testing to be completed, and another 3 months for their results to be interpreted and a care plan discussed. In the face of these long lag times and ensuing backlog of patients needing care, Dr. Nathan Hoag and colleagues Dr. Harold Hunt, Dr. Chasta Bacsu, and Dr. David Quinlan wanted to improve patient flow, streamline access to care, and connect patients with appropriate diagnostic testing and treatment in a more timely fashion.
Using two consecutive grants from the South Island MSA’s Facility Engagement funding, the group convened a series of meetings with a wide variety of stakeholders: the Departments of Urology, Obstetrics and Gynecology, urology nurses, medical administration within Island Health, outpatient services and electrodiagnostic services to better understand what factors were driving the long wait times and how to better coordinate care of patients. One of the key outcomes of this phase was arriving at a common agreement with administrators at Island Health that the current level of service was not acceptable and that changes were needed. Also notable was the improved collegiality, working relationships, and communication that arose between gynecologists and urologists.
Phase 2 of this project involved further engagement with Island Health managers, nursing leaders, allied health and various physician groups to ensure appropriate input into the design of an Island Health Bladder Care clinic. Dr. Ian Thompson from Medical Affairs, Sharon Parks, Director of Outpatient Management, and Erin Hohl from Endoscopy Administration, were instrumental in bringing the clinic to the current phase.
Pending a revised computer system to manage the service and some capacity building among nurses currently working in the Cystoclinic, the Bladder Care Clinic should be up and running in 2021. In the meantime, Island Health has undertaken the significant work of clearing the backlog of patients awaiting testing results. Instead of the previous once-a-week Urodynamics clinic, they have staffed and provided admin support for a clinic three times a week. In practice, this means that rather than waiting for 2-3 years from onset of symptoms to test results, patients can now expect to receive their test results and follow up consultation within 3-6 months.
This tremendous effort – to identify obstacles to better care, to build relationships with other providers, and to engage with Island Health administrators to generate a shared agreement about how to solve this problem – would not have been possible without the persistence and hard work of the project team members. Speaking about the value of the Facility Engagement funding, Dr. Hoag explained, “We needed the hours we were spending on this project to be covered, otherwise we just would have run out of steam”.
Congratulations to Dr. Hoag, Dr. Hunt, Dr. Bacsu, and Dr. Quinlan, and their committed colleagues at Island Health, Dr. Ian Thompson, Sharon Parks, and Erin Hohl for making this clinic a reality!