Quality and quantity: an audit of urodynamics practice in relation to newly published National Standards.
OBJECTIVE
To document urodynamic practice in Wales in relation to newly released National Minimum Standards with a view to influencing organisational change.


METHODS
Three questionnaires, evaluating respectively, departmental practice, individual practice and the last 10 studies performed in that department, were sent to all departments performing urodynamics in Wales. Results 19/20 departments responded. Approximately 4,000 studies are performed annually in Wales. Three departments do not perform enough studies annually to meet minimum standards. The minimum standard of 30 studies annually is not met by most centers evaluating neuropathic patients or performing ambulatory tests. Eighty four percent of departments have a clinical lead, one quarter discuss urodynamics in the context of a multi-disciplinary team meeting and occasional audits are performed. Fifty-four staff perform urodynamics, of which 35 (65%) have attended a course. Ability to describe zeroing a transducer was scored out of 6 and respondents scored a median of 3/6. One hundred twenty two out of 168 (72%) of the studies audited asked a clear urodynamics question, but, in 22/168 (13%) this question was not answered. The urodynamics report was written immediately 85% of the time.


CONCLUSIONS
Centers failing to meet the minimum standards for workload should consider their position in relation to standards and NICE guidance (UKCS, NICE). In particular, departments should give attention to standards described in "Good Urodynamic Practice," establish multi-disciplinary teams for continence management and consider greater centralization of investigations for patients with neuropathies and for ambulatory studies. Most staff attended a course, yet few can describe how to zero transducers. This raises questions about the quality of reporting of some urodynamic studies. Those that are involved in urodynamics should take part in regular CME, relevant audit and consider certification and revalidation. This audit has highlighted significant variations in practice and lends support to the application of nationally agreed standards.
Morriston Hospital, Swansea, United Kingdom. katiemoore@doctors.org.uk
K C
KC
Moore
S J
SJ
Emery
M G
MG
Lucas
D000328:Adult; D005260:Female; D006176:Gynecology / Q000592:standards*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D014563:Urodynamics; D014572:Urology / Q000592:standards*; D014852:Wales