Urology Rundown
Service and team structure
ACH Urology covers the acutes for all three DHBs.
There are 3-4 HOs. Despite being allocated a team each, it is really up the house officers how to divide the workload.
All the registrars are really approachable so if there are any concerns or questions, just ask them.
The bosses are also all really nice, and are willing for you to ask questions or call them if there is a problem with one of their patients (especially if the registrar is unavailable).
Daily routine
0700 arrive to print patient list and check overnight events
0715 run the list with the team, then ward round with the on call consultant
Note: Consultants/fellows with a theatre list may ward round on their post-op patients – they may request one house officer to join. Ward rounds are fast - the best way to manage is for the HOs to alternate between rooms. The nurses will leave the files by the patient’s bed for the ward round.
Usually there is team coffee/breakfast to re-run the list and divide the jobs after the ward round.
Suggested triage order for jobs: Acute booking for theatre > Radiology > Interventional Radiology (nephrostomy tube, stents, percutaneous drains) >fluoroscopy (nephrostogram, cystogram, urethrogram, conduitogram) >referrals (especially ID – bacteraemia should see all patients with PBCs automatically) >discharges.
Arranging discharge follow up can be complex, follow the algorithm displayed on the ward. In the afternoons, review any sick patients and all investigations.
Put up bloods for following day. Run the list (patients’ progress during the day) with registrar before you go home.
Patient list
The patient list is just a screenshot of acute Urology patients in Whiteboard, arranged according to ward and room number. Arrange the list with enough space to write jobs and paste screenshot into word document to print. Add columns next to each patient to tick off as you go: ‘labs’ ‘MSU’ ‘abx’ this will help you stay up to date with the patients.
Urine list
Check ALL urines for elective patients for the following week (the booker will send the list through your work email on Thursday, however you may need to make a list of elective patients earlier in the week from the theatre lists). Contact patients if they require urine tests or antibiotics for a UTI. Ensure all patients have a urine test request early in the week. Male patients require 5 days minimum of antibiotics if UTI, female patients require at least 3 days. Give antibiotics right up until the operation. If patients are un-contactable, ensure the registrar/SMO operating the list is aware. Patients can get cancelled if urines are untreated.
Most patients require urines/antibiotics, unless the procedure they are having does not require exploration of urinary tract or high pressure cystoscopies.
On call
On long day you cover Ortho and Urology 1600–2230. There is a Urology registrar until 2230 and overnight the General Surgical registrar covers Urology.
On weekends you only cover Urology. Morning starts with ward round with acute consultant and ward jobs.
Sometimes if there is an Ortho HO covering urology on the weekend, they may not do the correct follow up planning for discharges (as listed on the algorithm on the ward), so you will need to allocate time on Monday to go through them. Try to communicate with your Ortho colleagues about the expectations.
Tips
The orientation book has sections on basic management of common urological conditions. Beware of the haematuric patients with past medical history significant cardiac disease as they may need higher Hb target.
You can now request an MSU and send prescriptions online.
To request MSU online: Go to Clinical Portal > ‘orders’ tab >‘place without encounter’ button on the bottom right > ‘Community laboratory orders’ > fill in order form.
To send a prescription online: Go to Clinical Portal > ‘Rx’ button > INDICI e-prescribing > Find and select the medicine you with to prescribe > ensure it is ‘ticked’ then click ‘generate prescription’ and email it to the patient’s preferred pharmacy.