To what extent have key recommendations from the Getting It Right First
Time programme for urology in England been implemented?
Rationale, aims and objectives: The Getting It Right First Time (GIRFT)
programme was set up to reduce unwarranted variation in healthcare
practice and outcomes in England. The aim of this study was to
investigate early changes in practice in urology based on the
recommendations made. Key recommendations included: 1) to increase rates
of day-case surgery for transurethral resection of bladder tumour
(TURBT), 2) to reduce use of stenting as a primary procedure for
emergency presentations with ureteric stones and 3) to reduce waiting
times for male bladder outflow tract surgery following emergency
presentation with urinary retention. Methods: Data on patient age, the
treatment provider, dates of admission and discharge, diagnoses and
procedures conducted were extracted from the Hospital Episodes
Statistics database from January 2014 to December 2019. The dates of
visits by members of the GIRFT team was taken as the intervention point.
Interrupted time series analysis was used to identify trends pre- and
post-intervention. Results: There was evidence of a significant increase
in the proportion of patients seen as day-cases for TURBT and decreased
use of stents and increased use of ureteroscopy or extracorporeal
shock-wave lithotripsy on first presentation with ureteric stones
following GIRFT visits. However, there was no significant change in
waiting times for surgery to treat patients who had an emergency
presentation with urinary retention. Conclusions: In the first 18 months
following the last of the GIRFT visits, there is some evidence that the
recommendations made are already having an impact on clinical practice.
The reasons why some recommendation appear to be harder to implement
requires further investigation.