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To what extent have key recommendations from the Getting It Right First Time programme for urology in England been implemented?
  • +1
  • William Gray,
  • Jamie DayOrcid,
  • Tim Briggs,
  • Simon Harrison
William Gray
NHS England and NHS Improvement London
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Jamie Day
Orcid
NHS England and NHS Improvement London
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Tim Briggs
NHS England and NHS Improvement London
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Simon Harrison
Pinderfields Hospital
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Peer review status:POSTED

01 May 2020Submitted to Journal of Evaluation in Clinical Practice
02 May 2020Assigned to Editor
02 May 2020Submission Checks Completed

Abstract

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.