Hawkes Bay DHB

Trish White - MCNA, BN, MN (Dist) Hawkes Bay DHB.
Nurse Practitioner: Adult Urology (prescribing)

Service Delivered

1. Outpatient clinics to provide both First Specialist Assessments (FSA) and follow-up appointments to Urological patients.  Patients are referred by health professionals including GP’s and Nurses in Primary Health Care directly to the NP or triaged by the Urologist to the NP clinic.  Examples of types of patients reviewed in these clinics include:

• Lower urinary tract symptoms (e.g. Prostate clinic, voiding disorders)
• Recurrent urinary tract infection
• Continence
• Haematuria
• Oncology surveillance

2.  Case Management of complex urology patients.  Home visits provided for up to 100 patients per month.  The aim is to prevent readmission while providing care in the  most appropriate environment.

3.  Consultancy role in DHB, Primary Health Care, NGOs regarding Urological issues, participation in research and teaching at post-graduate level.

Implementation/funding of NP Position

1. Application to the MOH Elective Services Initiatives Fund in 2005 secured funding for a six month trial of the Urology NP position.
2. The project’s success measure was a reduction in Elective Services Performance Indicator Two (ESPI 2) i.e. the number of patients waiting longer than six months for FSA in Urology Services.
3. As the project was successful the DHB committed to continue delivering the service and provided ongoing funding for the NP position. 

Outcomes

1. Urology NP clinics have significantly cut down waiting times for FSA. Most men are now seen within one to two months of referral which is well within MOH guidelines.
2. In the past two years 140 patients have been seen by the Urology NP for their First Specialist Assessment in the Outpatient Department.  This accounts for 10% of all FSA’s seen in Urology over the time period.  Fifty percent of patients were managed independently by the NP, who referred the other 50% to the Urologist (48.5% of this group required surgery).
3. Appropriate NP referrals to the Urologist and discharges patients back to the GP with an ongoing management plan included in documentation.
4. Patients have a timely review and a treatment plan is put in place to improve their health with a focus on health promotion. The NP has a longer appointment time allowing a focus on patient education and self management of symptoms.

Evaluation

• “The development of a Prostate Clinic led by the countries only Urology NP has helped reduce by 87% the number of men waiting longer than six months to see a urology specialist in the Hawke’s Bay DHB”.
  MOH (2006).  Implementing the New Zealand Health Strategy 2006, pp 90-91

• “The NP Service has allowed the Urologist to focus on high acuity patients and use his expert skills where they are needed most. 
   Urology patients have benefited through the good example of effective interdisciplinary care. 
   The success of this project highlights the benefits of having more NPs working in acute 
   and elective services.”
  Jane Craven, Senior Advisor, MOH, February 2006

Feedback on NP contribution

• “Thank you and your organisation for your initiative that is profiled in my annual report.  Initiatives such as yours are hugely important in achieving the New Zealand Health Strategy objectives to ensure a healthier New Zealand – for all New Zealanders.  Your work exemplifies the innovation and commitment required to make a positive difference to New Zealand Communities.”
  Hon Pete Hodgson, Minister of Health (2007), Personal Communication