Overview
Initiative type
Service Improvement
Status
Deliver
Published
June 2026
Summary
Critical workforce shortages in the Urology profession have contributed to prolonged wait times and limited access to conservative care for Urology patients. Allied health first models of care have been shown to be effective in Urogynecology settings(1), but limited evaluation exists in male and female Urology Patients. In September 2023 a novel multidisciplinary model of care was implemented at Redcliffe Hospital to help mitigate these wait times: the Pelvic Health Physiotherapy Screening Clinic (PHPSC).
Dates: September 2023 - November 2024
Implementation sites: Redcliffe Hospital
Aim
The aim of this single site quality improvement project was to evaluate the extent to which the PHPSC performed its intended functions of improving: patient access, clinical outcomes, patient experience, urology waitlist reduction, health professional experience and streamlined medical management (if still required). Cost effectiveness of the service was also evaluated.
Outcomes
- This evaluation demonstrated that the PHPSC model is an effective, patient-centred, and cost-efficient alternative to traditional care pathways.
- This physiotherapy-led model significantly improved access to Urology care reducing category 2 Urology wait times by 81% (from 23.3 months to 4.5 months) and contributing to a 54% decrease in the overall total Urology waitlist.
- Clinical outcomes post PHPSC input were positive with 59% of patients managed without medical specialist input and improvements reported in 85% of patients who completed the GROC scale.
- The PHPSC model reduced Urology follow-up demand, with 31% (n=15) of patients referred back to Urology requiring fewer specialist appointments.
- Patients who completed the patient satisfaction survey rated their overall experience, on average, 4.9/5 (n=17).
- Both patient and clinician feedback strongly supported the PHPSC continuation, citing improved care quality, access, and satisfaction.
- Despite funding and staffing challenges, the PHPSC was cost-effective with generated revenue outweighing operational costs.
Background
The Australia wide critical workforce shortages in the Urology profession have contributed to prolonged wait times and limited access to conservative care for Urology patients. In 2023 the Urology specialist waitlists at Redcliffe Hospital were incredibly long, consisting of approximately 800 Category 2 patients with the longest wait >2 years. This was identified on the Metro North Risk Register as impacting on patient’s access to timely care.
Urinary incontinence is increasing in prevalence. The Continence Foundation of Australia reports one in four Australians experience incontinence with the 2023 National Consumer survey finding that 39% of Australians (24.2% females and 14.8% males) reported having or have had incontinence in the past(2). Current evidence states ‘A pelvic health clinic led by advanced practice physiotherapists is an effective model of care for management of stress urinary incontinence, overactive bladder and pelvic organ prolapse’(3). Physiotherapy is also recommended as first line management for urinary incontinence, vaginal prolapse and pelvic floor dysfunction (grade A recommendation, level 1 evidence)(1).
Due to the above evidence, the PHPSC was introduced in September 2023 as a multidisciplinary alternative care pathway for the Redcliffe Hospital Urology waitlist patients and temporarily funded to continue until November 2024.
To determine the extent to which the clinic performed its intended functions and aims, an evaluation of patients who were transferred to this pathway was conducted. In July 2025, the PHPSC was provided further temporary funding for 12 months, with a hope to transition this to a permanent funding model into the future.
Methods
Patients were transferred to the PHPSC alternative care pathway if they met the following inclusion criteria:
- Female (sex at birth) – urinary incontinence, urinary frequency, urinary urgency, prolapse
- Male (sex at birth) – simple urinary incontinence, urinary frequency Included patients were screened by an Advanced Pelvic Health Physiotherapist and if suitable, offered a trial of conservative management with a Physiotherapist and Continence Nurse.
At this initial appointment, screening for red flags and clinical concerns also occurred, and were case conferenced with the Urologist as required. After the trial of conservative treatment, the patient was reassessed and either reinstated to the Urology waitlist (at the same position as when referred) or discharged back into the care of the GP.
A post inception audit was conducted of all patients (n=138) who had been transferred to the PHPSC pathway between 11 September 2023 and 28 November 2024. Routine patient data, referral and discharge information, as well as the GROC outcome measure was collected.
Additionally, a retrospective chart audit of all patients (n=56) reinstated to the Urology waitlist was conducted to analyse occasion of service numbers and outcome of Urology visits. All patients who attended the PHPSC were offered to anonymously complete a Microsoft Forms satisfaction survey via a QR code link on discharge from the service. To evaluate the healthcare professional experience, all clinicians involved were invited via email to complete an anonymous Microsoft Forms survey.
All collected data was collated and de-identified prior to being exported to SPSS for cleaning and descriptive analysis.
Discussion
For the PHPSC alternative care pathway to succeed, support was required and provided from the Redcliffe Hospital Urology Department, Executive Management and Medical Service Line. This included, but was not limited to, additional clinical rooms and temporary Physiotherapy staffing contracts. The strengths of this project were the unanimous support of the Urology, Medical Service Line, Allied Health and Physiotherapy Directors. At the evaluation timepoint, the Redcliffe Hospital Research team were a valued resource providing support and guidance. Additionally, financial support through a Redcliffe Hospital Private Practice Trust Fund grant was invaluable to enable the successful analysis and dissemination of the project outcomes.
Several limitations occurred during the PHPSC period. The main limitation occurred around temporary funding being approved in short three to six-monthly periods making recruitment and retention of Physiotherapy clinicians challenging. Lateral thinking was required in some instances where clinics were required to be conducted via phone due to critical clinic room shortages. Patient satisfaction survey response was inhibited by survey fatigue and poor internet reception in treatment and waiting rooms leading to a low completion rate. In response to the limited access of the satisfaction survey via QR code, an SMS survey link was developed early in the project period. The SMS link improved patient completion rates but unfortunately the approval process was lengthy, and implementation was towards the end of the project pilot period.
The Redcliffe Hospital PHPSC alternative care pathway met all its intended key goals of improving access to care, reducing long waits and the quadruple aim of healthcare: improved patient outcomes, enhanced patient experience, better staff satisfaction, and cost-effectiveness. This pilot provides a strong business case for permanent integration and broader adoption of allied health-led models in pelvic and urological care.
In response to the evaluation and positive outcomes, the PHPSC was funded temporarily for a further 12-month period at Redcliffe Hospital. The clinic outcomes were disseminated within the Queensland Women’s, Men’s and Pelvic Health Network (QWMPHN) and from this, a further two Queensland Health sites have now implemented a similar model for Urology patients. Future direction includes permanent funding and implementation of the PHPSC clinic at Redcliffe Hospital as well as continued expansion statewide. Furthermore, additional retrospective analysis could be completed to assess the wider and longer-term Urology service impact and cost savings to solidify the value of this service.
References
1. NICE Guideline [NG210]. Pelvic Floor dysfunction: prevention and non-surgical management. 2019: http://www.nice.org.uk/guidance/ng123
2. Continence Foundation of Australia (2024, March,18). National Consumer Survey Analysis Report 2023, https://www.continence.org.au/sites/default/files/2024-03/National%20Consumer%20Survey%20Analysis%20Report%202023_External_18032024_LR.pdf
3. Howard et al. Outcomes of a physiotherapy-led pelvic health clinic. Australian New Zealand Continence Journal 2018. 24 (2) 43-50.
Key contact
Katie Roderique
Physiotherapist - Advanced
Redcliffe Hospital
Metro North Hospital and Health Service