Modernising a community-based vasectomy service
ESC Congress Library. Mullin N. 05/28/14; 50597; A-182
Dr. Nicola Mullin
Dr. Nicola Mullin
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Abstract
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Background


Male and female sterilisation operations were once popular in the United Kingdom but since the introduction of a drive to increase the uptake of long acting methods of contraception, linked to the national target of reducing teenage pregnancies, the number of sterilisations has fallen dramatically: 26,400 vasectomies were performed in 2006-7 in England and Wales which decreased to 10,400 in 2011-12. The reorganisation of the National Health Service has also created financial pressures on community contraception services. Changes in society with more men having second families in later life may be another factor influencing decisions about permanent methods of contraception.


In 2011 a community based vasectomy service decided to review its structure and organisation to maximise efficiency and effectiveness. We were determined to become even more patient centred. A number of changes were introduced and evaluated.


Method


One area of cost saving identified possible changes to the staffing structure: over a year the roles of the scrub and circulating nurses were changed from a specialist nurse post to a lower band health care assistant. An internal competency based training package was designed and introduced.


Another major change was to identify ways of reducing the number of men who booked an appointment for counselling or an operation but then failed to attend on the day: the ‘did not attend' (DNA) rate in a previous audit conducted in 2010 was 15%. Informal feedback from men suggested that Monday daytime was not the best time in the week to offer appointments. After negotiation with stakeholders we made three significant changes to the organisation of the community vasectomy service: we launched a same day counselling and operation service, changed the day from Monday to a Friday and became a self-referral service (no longer requiring men to be referred by their family doctor/GP).


Results


An audit of the first 8 months of the redesigned service found a significant reduction in DNA rates in both self-referrals (SR) and GP referrals. Total number of SR clients for counselling was 59 for counselling with only 2 DNAs (3.3%) and 64 for operations with no DNAs. Total number of GP referrals for counselling was 63, 7 DNAs (11.1%) and operations was 56, 6 DNAs (10.7%).


Conclusions


By modernising our vasectomy service it has become more efficient and patient centred. The same day Friday service has been shown to be convenient and highly acceptable to men.


 


 


 


 


 


 

Background


Male and female sterilisation operations were once popular in the United Kingdom but since the introduction of a drive to increase the uptake of long acting methods of contraception, linked to the national target of reducing teenage pregnancies, the number of sterilisations has fallen dramatically: 26,400 vasectomies were performed in 2006-7 in England and Wales which decreased to 10,400 in 2011-12. The reorganisation of the National Health Service has also created financial pressures on community contraception services. Changes in society with more men having second families in later life may be another factor influencing decisions about permanent methods of contraception.


In 2011 a community based vasectomy service decided to review its structure and organisation to maximise efficiency and effectiveness. We were determined to become even more patient centred. A number of changes were introduced and evaluated.


Method


One area of cost saving identified possible changes to the staffing structure: over a year the roles of the scrub and circulating nurses were changed from a specialist nurse post to a lower band health care assistant. An internal competency based training package was designed and introduced.


Another major change was to identify ways of reducing the number of men who booked an appointment for counselling or an operation but then failed to attend on the day: the ‘did not attend' (DNA) rate in a previous audit conducted in 2010 was 15%. Informal feedback from men suggested that Monday daytime was not the best time in the week to offer appointments. After negotiation with stakeholders we made three significant changes to the organisation of the community vasectomy service: we launched a same day counselling and operation service, changed the day from Monday to a Friday and became a self-referral service (no longer requiring men to be referred by their family doctor/GP).


Results


An audit of the first 8 months of the redesigned service found a significant reduction in DNA rates in both self-referrals (SR) and GP referrals. Total number of SR clients for counselling was 59 for counselling with only 2 DNAs (3.3%) and 64 for operations with no DNAs. Total number of GP referrals for counselling was 63, 7 DNAs (11.1%) and operations was 56, 6 DNAs (10.7%).


Conclusions


By modernising our vasectomy service it has become more efficient and patient centred. The same day Friday service has been shown to be convenient and highly acceptable to men.


 


 


 


 


 


 

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