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Cutting unnecessary emergencies – Tiziana Ansell

Blog posted by: Tiziana Ansell, 21 June 2016.

In the latest blog marking World Continence Week, a specialist nurse from South London’s Health Innovation Network describes the work going on across emergency departments:

At South London Health Innovation Network we are working to reduce catheter-associated urinary tract infections by 30 per cent by 2017 and to improve patient wellbeing and recovery.

We carried out several audits across South London to find out how many patients attend Emergency Departments with catheter problems, and what interventions would improve patients’ care experience and their quality of life.

I want to share the story of John, an 80-year-old man patient and our journey to address his care needs.

John lives by himself in his own home. He has a long-term urethral catheter, which he will need for the rest of his life because he has an inoperable enlarged prostate, and a number of co-morbidities and complex care needs. In the last two years John has attended the ED 40 times, travelling to and from the hospital by ambulance.

In the last year at least, ten of John’s ED visits were for urinary catheter problems, including catheter blockage, bypassing urine between the catheter and urethra due to poor drainage, catheter pain and accidental trauma, and recurrent catheter-associated urinary tract infections (CAUTIs). John also suffered from a serious case of uro-sepsis, which was attributed to the presence of the catheter and made him very ill, leading to a long hospital stay.

He depends on community nurses and social care support to continue living independently in his own home, and infections and hospital stays affect his independence and wellbeing. This could mean he has to move to a care home for more support.

John is one of eight patients we audited who were visiting the ED regularly with catheter problems. If these eight patients had individualised and responsive community services, ED attendances would be significantly decreased, and London Ambulance Service would have increased availability to attend emergency cases. This would also improve the quality of life for these patients, and for John, it would allow him to maintain his independence and remain in his own home.

As a result of the HIN’s recent ED audit, we collaborated with local specialist services, including a continence nurse specialist, a urology nurse specialist, community matrons and the rapid response team.

We will now work alongside these eight patients to give them an individual, responsive service that’s tailored to their complex needs. We are also talking to the 111 services and the ambulance service, to design individualised care-planning for this group, to help us manage their care more successfully in the community.

  • NHS England’s Excellence in Continence Care is a practical guide for commissioners, providers, health and social care staff to put into effect the best care for patients. It also provides information for the public.


Image of Tiziana AnsellTiziana Ansell is a registered nurse, independent nurse prescriber and Darzi Fellow.

She specialised in continence care in 1999 and has been working in the field since.

Tiziana works for the Health Innovation Network on a two-year project to reduce catheter-associated urinary-tract infections (CAUTIs) in South London. She has 20 years’ clinical and managerial experience working in the UK across community, acute and private sector.

Prior to moving to the UK she also worked in Italy as a volunteer and paramedic in the ambulance service and underwent work experience in Slovenia in neuro-surgery intensive care unit.


Channel website: https://www.england.nhs.uk/

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