Alternative approaches to expanding pediatric urology services and productivity

We critically assessed the outcomes of a new model of pediatric urology delivery using alternative approaches to expand care without increasing the number of pediatric urologists. The approaches included the use of advanced practice nurse practitioners, pediatric physician specialists, part-time contract pediatric urologists from neighboring institutions and part-time contract adult urologists from our university.

Data were collected from the Division of Pediatric Urology at Arkansas Children's Hospital during 2009 and 2010. The only pediatric urologist at our institution retired in December 2009 with an immediate transition to a new pediatric urologist in January 2010. Comparisons were made in the numbers of clinic visits, inpatient admissions/consultations, surgical volume and patient satisfaction scores.

Average clinic monthly visits in 2009 and 2010 were 153 and 271, respectively (p <0.0001). Inpatient admissions increased from 43 in 2009 to 162 in 2010. Inpatient initial consultations and followup consultations increased by 115 and 112, respectively, from 2009 to 2010. Surgical volume increased 26.7% in 2010 (p = 0.0832) and Press Ganey® scores were comparable or improved from 2009 to 2010.

The use of advance practice nurse practitioners, part-time contract adult and pediatric urologists, and pediatric physician specialists can effectively increase the number of patients treated without adding full-time pediatric urology staff. The assignment of patient and disease populations to each team member has been an ongoing process of critically defining and updating responsibilities in an attempt to expand care, increase productivity and maximize the quality of delivery of these services.