Clinical Trial Details
— Status: Recruiting
Administrative data
| NCT number |
NCT06152679 |
| Other study ID # |
327246 |
| Secondary ID |
|
| Status |
Recruiting |
| Phase |
|
| First received |
|
| Last updated |
|
| Start date |
December 1, 2023 |
| Est. completion date |
October 1, 2024 |
Study information
| Verified date |
November 2023 |
| Source |
Royal Devon and Exeter NHS Foundation Trust |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Observational
|
Clinical Trial Summary
A qualitative research study interviewing patients treated in hospitals across England. We
will interview patients who have recently undergone one of the following operations as a
day-case; transurethral bladder tumour resection (TURBT), transurethral resection of prostate
(TURP) or transurethral enucleation of the prostate (TUEP). We are interested to find out
about the experience for patients who go home on the day of surgery after they have had one
of these operations. We hope that the findings will tell us about how to improve the
experience for patients in future.
Patients undergoing day-case surgery at a range of different hospitals from across England
with varying day-case rates will be interviewed. Hospitals in large city and more rural areas
will be included. Interviews are anticipated to take place over a six month period. The study
will end when "saturation" is achieved, whereby no new themes are identified through
interviews. Saturation will be sought for each individual operation of interest.
Description:
Safe day-case surgery pathways offer to reduce pressure on hospitals by avoiding overnight
inpatient admission. This is particularly relevant given the intense pressures on hospital
resources in the United Kingdom. Urological surgery includes a number of frequently performed
operations for which safe day-case surgery pathways have been demonstrated, but for which day
surgery is routine widespread routine practice. These include bladder tumour resection
(TURBT), and prostate resection or enucleation using diathermy or laser (TURP and TUEP). All
of these operation types involve endoscopic access to the bladder via the urethra, and do not
involve skin incisions. They can be performed under general or spinal anaesthesia.
For 12 months from December 2021, the national average day-case rate for transurethral
resection of bladder tumour In England was 21.1%, and ranged from 0% to 87.3% at different
hospitals, with an interquartile range (IQR) of 10.5% to 37.7%, and 23,071 cases performed in
total. For bladder outflow obstruction surgery the median day-case rate was 7.7% (range 0% to
82.4%, IQR 4.4% to 19.1%, 18,912 cases), and this includes TURP and TUEP. This demonstrates
that for these common operations there is significant variation in practice across England.
The Getting It Right First Time (GIRFT) Urology programme advocates for a "day-case by
default" approach to TURBT, and that day-case surgery should ideally be offered for prostate
resection and enucleation. As well as reducing pressure on inpatient services, greater
day-case adoption offers to reduce financial costs, shorten waiting lists by allowing greater
access to day-case theatres away from the acute hospital, and reduce environmental impact by
adopting a less resource-intensive approach. It also offers a more standardised patient
experience, however we do not understand a great deal about the lived patient experience
after discharge.
National day-case rates for of TURBT, and bladder outflow obstruction surgery using TURP or
TUEP, have increased over the past five years. Many hospitals have well-established pathways,
whilst others are newly adopting this approach, or not yet adopting day-case surgery for
these operation types at all. There is an opportunity to understand the patient experience of
different day-case surgery pathways for these operations of interest, so that we might
understand factors contributing to a favourable or unfavourable experience. This knowledge
could inform future day-case pathway development and modification is a way that is more
acceptable for patients.
To explore this area, we intend to perform qualitative research involving patients. We will
interview patients who were treated at a range of different hospitals with differing day-case
performances.
