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Uro-Gynaecology From Cambridge to UAE? May 2018 UAE
Uro-Gynaecology From Cambridge to UAE? May 2018 UAE
Uro-Gynaecology From Cambridge to UAE? May 2018 UAE
Uro-Gynaecology From Cambridge to UAE? May 2018 UAE
Uro-Gynaecology From Cambridge to UAE?
Uro-Gynaecology From
Cambridge to UAE?

May 2018 UAE

Are there any existing Abu Dhabi Uro-Gynaecology Services?
Are there any existing Abu Dhabi
Uro-Gynaecology Services?
Detailed Google search:
Detailed Google search:

22 centres in Abu Dhabi cited as providing treatment for incontinence and prolapse

On analysis of the cited specialists and services:

There is no dedicated Uro-Gynaecology and Female Pelvic Floor Disorders unit in Abu Dhabi

There are no subspecialist accredited Urogynaecology consultants

and Female Pelvic Floor Disorders unit in Abu Dhabi • There are no subspecialist accredited Urogynaecology
What is a Uro-Gynaecologist? Uro-Gynaecology (UG): Sub-speciality of gynaecology dealing with benign disorders of the
What is a Uro-Gynaecologist?
Uro-Gynaecology (UG): Sub-speciality of gynaecology dealing
with benign disorders of the lower urinary and genital tract,
mainly urinary incontinence and genital prolapse.
A Uro-Gynaecologist: 1. Has evidence of training in a specialist unit, providing the full range
A Uro-Gynaecologist:
1. Has evidence of training in a specialist unit, providing the full range of investigations and
treatments required for practice as a subspecialist.
2. Has advanced urodynamics experience (e.g. Special Skills Training).
3. Provides >2 urodynamic sessions per month (in person or a supervisory capacity).
4. Provides 3 general clinical sessions in UG per week.
5. Provides a minimum of 1 specialist combined UG clinic per month as part of an MDT
(e.g. Childbirth trauma, combined colorectal, combined functional and neuro-urology).
6. Undertakes at 1-2 major UG procedures associated with pelvic floor dysfunction
(i.e. incontinence and prolapse) per week per year.
7. Audits their practice (e.g. BSUG surgical audit).
8. Undertakes annual appraisal demonstrating a proportion of CME in UG.

Career background

From

Locum Consultant Gynaecologist Urogynaecology, Paediatric Adolescent Gynaecology and Reproductive Medicine Cambridge University Teaching Hospital(s) NHS Foundation Trust (CUHFT), Cambridge UK.

02/2017

2003-2016

Consultant Urogynaecologist, Reconstructive Pelvic Surgeon, Perineal/Childbirth Injury, Paediatric Adolescent Gynaecology, St. George’s University Hospitals NHS Foundation Trust and St George’s University of London.

2005-2015

Preceptor for RCOG/BritSPAG and RCOG/BSUG Advanced Training Skills Modules (ATSMs).

2003-2016

Honorary Senior Lecturer for Obstetrics and Gynaecology, at SGUL, London, UK.

2003-2012

Uro-Gynaecology subspecialty RCOG Training Program Director based at St George’s Hospital, London, UK.

2002-2003

Completed a subspecialty training at SGUH FT and accreditation for Urogynaecology by the RCOG.

1999-2002

Subspecialty training programme completed. Accreditated with Diploma Urogynaecology awarded by RANZCOG.

2000-2001

Consultant Gynaecologist, Mercy Hospital & Austin Repatriation Medical Centre Victoria, Australia. Senior Lecturer University of Melbourne Australia

2000

Doctorate of Medicine (MD) for research awarded by the National University of Ireland.

2000

Diploma Advanced Ultrasound (DipUS), RCOG and Royal College of Radiology (RCR), London, UK.

1997-1999

Senior Lecturer Obstetrics & Gynaecology, Cambridge University, Cambridge, UK.

1996

Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG).

1995

Lecturer Obstetrics & Gynaecology, University College Dublin, National Maternity Hospital, Ireland.

College Dublin, National Maternity Hospital, Ireland. Michelle Checinska-Fynes MB BAO BCH (Hons) MD (Research)

Michelle Checinska-Fynes MB BAO BCH (Hons) MD (Research) MRCOG DU DipUS

Dual subspecialist accredited Uro-Gynaecologist RANZCOG 2002 and RCOG 2003 RCOG Subspeciality Training Programme Director 2003-12 Service Lead for Uro-Gynaecology 2003-2012 Specialist Paediatric Adolescent Gynaecology

14.5 years experience NHS Consultant Uro-Gynaecologist

What should a subspecialist Urogynaecology and Pelvic Floor Disorders Unit comprise? Core medical team Clinical
What should a subspecialist Urogynaecology and
Pelvic Floor Disorders Unit comprise?
Core medical team
Clinical space and equipment
• Lead Uro-Gynaecologist
• Dedicated clinical space

Clinical Nurse specialist

Physiotherapist

Perineal Care Midwife

Link to colorectal services

Link to neurology services

Link to pain anaesthetist

Urodynamics equipment

Ultrasound (TVUS Endo-anal) and Bladder scanner

Outpatient cystoscopy (for diagnostics, Botox, bulking)

Anal manometry and basic EMG

Capacity to undertake minor outpatient surgical procedures

Capacity to undertake outpatient local pain blocks

IT access and medical physics support

What spectrum of conditions does a subspecialist Uro-Gynaecology and Pelvic Floor Disorders Unit treat?

Sexual dysfunction (e.g. dyspareunia, vaginismus, loss of libido) Childbirth injury (e.g. Obstetric Anal Sphincter Injury
Sexual dysfunction (e.g. dyspareunia, vaginismus, loss of libido)
Childbirth injury (e.g. Obstetric Anal Sphincter Injury [OASI], fistula)
Females of all ages with Urinary Incontinence and Urogenital Prolapse
Females of all ages with Urinary Incontinence
and Urogenital Prolapse
Other Lower Urinary Tract Disorders • Recurrent urinary infection • Overactive bladder • Painful bladder
Other Lower Urinary Tract Disorders
• Recurrent urinary infection
• Overactive bladder
• Painful bladder disorders
• Difficulty with bladder emptying
• Urogenital fistula
• Urethral diverticula
Complications POP and UI surgery (e.g. mesh) Urogenital pain disorders
Complications POP and UI surgery (e.g. mesh)
Urogenital pain disorders
Bowel disorders • Incontinence • Defecatory difficulty
Bowel disorders
• Incontinence
• Defecatory difficulty

These problems are effectively treated within specialist clinics provided by the Urogynaecology & Pelvic Floor Disorders Team

are effectively treated within specialist clinics provided by the Urogynaecology & Pelvic Floor Disorders Team
Why does Abu Dhabi need a Subspecialist Uro-Gynaecology and Pelvic Floors Disorders unit? Urinary Incontinence
Why does Abu Dhabi need a Subspecialist Uro-Gynaecology and
Pelvic Floors Disorders unit?
Urinary Incontinence (UI) affects
10-20% women aged 15-64 years
30-40% >60 years
50% in long-term care facilities
1 in 8 women will have surgery for urinary incontinence
Pelvic Organ Prolapse (POP) affects
50% women >50 years of age
30-50% lifetime prevalence
10% lifetime risk surgery
13% 2 nd operation within 5 years
30% have further surgery for POP/SUI in their lifetime

‘Effective care requires a broad and detailed understanding of normal and

abnormal bladder bowel and pelvic floor muscle function in order to provide the right care package (e.g. surgery), at the right time, for the right patient, by the right doctor. UAE websites typically offer the procedure (e,g, we undertake TVT) rather than the package of care.‘

(e,g , we undertake TVT) rather than the package of care.‘ PUBLISHED FACT: Subspecialist Uro-Gynaecology and
PUBLISHED FACT: Subspecialist Uro-Gynaecology and Pelvic Floor Disorders centres with accredited consultant providers
PUBLISHED FACT: Subspecialist Uro-Gynaecology and
Pelvic Floor Disorders centres with accredited consultant
providers have better outcomes, fewer complications and
can offer a wider variety of treatments.
What would an enhanced subspecialist Uro-Gynaecology and Pelvic Floor Disorders unit look like?

What would an

enhanced subspecialist

Uro-Gynaecology and

Pelvic Floor Disorders

unit look like?

In-house referrals

along agreed pathways

Adolescent or

paediatric urology

referrals or transition

cases referrals

Referrals from other maternity services Postnatal referrals from the ward or other maternity hospital services
Referrals from other
maternity services
Postnatal referrals from the
ward or other maternity
hospital services
dbirth related antepartum
irst six months postpartum
Referrals from antental
or booking clinics
Referrals from
physiotherapy on agreed
pathways

Vision for a UAE based subspecialist service

Health Clinic Referrals

Family Doctor (GP)

Uro-Gynaecology and Female Pelvic Floor Disorders Unit Chil or f

Uro-Gynaecology and

Female Pelvic Floor Disorders Unit

Chil

or f

Non-childbirth related:

Adolescent

Premenopausal

Postmenopausal

Elderly care medicine

Premenopausal Postmenopausal Elderly care medicine A&E or self referrals Referrals from other SEHA and

A&E or

self referrals

Referrals from other

SEHA and non-SEHA

Hospitals

Referrals screened triaged to the correct care pathway and clinic;

General Uro-Gynaecology (primary incontinence and prolapse),

Childbirth Injury (OASI), Sexual Difficulties,

Complex or combined (e.g. bowel incontinence, recurrent prolapse, mesh complication)

bowel incontinence, recurrent prolapse, mesh complication) Nurse Led Women’s Health Triage for the Pelvic Floor
bowel incontinence, recurrent prolapse, mesh complication) Nurse Led Women’s Health Triage for the Pelvic Floor

Nurse Led Women’s Health Triage

for the Pelvic Floor Diagnostics Unit

Health Triage for the Pelvic Floor Diagnostics Unit First line conservative therapy for 3-6 months minimal
Health Triage for the Pelvic Floor Diagnostics Unit First line conservative therapy for 3-6 months minimal

First line conservative therapy for 3-6 months minimal investigations

formal assessment of outcome

Assessment

Diagnosis and Treatment

Hub

Uro-Gynaecology and Pelvic Floor

Disorders Service

Complex cases or red flags as indicated on the First line triage

flow chart and care pathway

Neuro-Urology and

Uro-Gynaecology

Disorders

Specialist Combined

MDT clinic

and Uro-Gynaecology Disorders Specialist Combined MDT clinic Referral to appropriate specialist clinic Uro-Gynaecology
and Uro-Gynaecology Disorders Specialist Combined MDT clinic Referral to appropriate specialist clinic Uro-Gynaecology

Referral to appropriate

specialist clinic

Uro-Gynaecology

and Colorectal

Disorders Specialist

Combined MDT clinic

Persistent symptoms and or request for

further therapy by patient that is deemed

Symptoms resolved or

improved and or patient

appropriate and in line with care pathways

Discussion or

MDT sign-off

General

satisfied

care pathways Discussion or MDT sign-off General satisfied Uro-Gynaecology Discharge to GP Paediatric and
care pathways Discussion or MDT sign-off General satisfied Uro-Gynaecology Discharge to GP Paediatric and
care pathways Discussion or MDT sign-off General satisfied Uro-Gynaecology Discharge to GP Paediatric and
care pathways Discussion or MDT sign-off General satisfied Uro-Gynaecology Discharge to GP Paediatric and

Uro-Gynaecology

Discharge to GP

Paediatric and

Uro-Gynaecology

 

Clinics

appropriate ongoing

Perineal

Secondary assessment clinical evaluation and or

diagnostics as indicated by the appropriate care

pathways discussion with patient

Adolescent Uro-

Gynaecology

Disorders

Specialist Combined

MDT clinic

Childbirth Injury

Clinic

pathway

Complex Urology &

Patient joins

M Fynes 04/2018

Expanding the UAE service referral base?
Expanding the
UAE service
referral base?
Expanding the UAE service referral base?
Care Pathways: Providing evidence based care for all Uro-Gynaecology and Pelvic Floor Disorders

Care Pathways:

Providing evidence based

care for all Uro-Gynaecology

and Pelvic Floor Disorders

The role of care pathways
The role of
care pathways

Care pathway:

First-line management of Urinary Incontinence Based on NICE Guidelines for management of urinary incontinence in women 2006. MMF pathway V2 April 2018

Incontinence Based on NICE Guidelines for management of urinary incontinence in women 2006. MMF pathway V2
The role of care pathways
The role of
care pathways

1. I have drafted 15 evidenced based care pathways

for the most common conditions referred to the Uro-

Gynaecology and Pelvic Floor Disorders.

2. These optimize success rates and minimize

morbidity whilst promoting patient safety.

3. The pathways may be incorporated into the IT

platform (e.g. EPIC) to facilitate compliance/audit.

Care pathway: Management

of Recurrent Stress Urinary Incontinence (SUI)

Robust Governance: 1. Clinical: Providing evidence based high quality patient centred care pathways with measurable

Robust Governance:

1. Clinical: Providing evidence based high quality patient centred care pathways with measurable and

recorded outcomes (including QoL)

2. Finance

3. Education and Training

Summary of Corporate and Clinical Governance aspects of proposed Uro-Gynaecology and Pelvic Floor Disorders Unit
Summary of
Corporate and
Clinical Governance
aspects of proposed
Uro-Gynaecology and
Pelvic Floor Disorders
Unit
Corniche
Corniche

Hospital

Uro-Gynaecology and Female Pelvic Floor Disorders Unit

Clinical Management, Business Structure, Governance and Quality Assurance

Financial Governance

1. Regular scheduled meetings with clinical, operational and administrative

managers, medical and clinical support staff.

2. Regular meetings including; governance, financial and service planning.

3. Service utilization audits and exploration options to improve business capture.

4. Mandatory attendance at >70% required per annum.

Financial Best Practice Care Pathway Costings and Service User Fees

determined with regular review utilizing:

1. Validate costs include Patient Reported Outcome & Morbidity (PROM) data

2. Utilize Financial and Clinical Governance processes to support tariffs

Clear tariff structures:

1. Individual and family pay as you go

2. Self-pay care packages

3. Insured care packages (agreed with insurance companies)

4. Insured as you go scheme

5. Company packages (e.g. direct with airlines, hospitality, engineering)

Service Development Promotion and Expansion:

1. Advertisement, brochures, website updates, podcasts

2. Patient Information Leaflets (PILs)

3. Meet the expert public promotion meetings

4. Ask the experts online Q&A

5. Patient service user feedback and testimonials

6. Publish favourable audit data

M Fynes V1 2018

Quality Assurance and Clinical Governance

Specialist Doctors, Nursing, Midwifery PG training, CPD updates, regular

attendance at relevant meetings

1. Personal and service audit

2. Demonstrate compliance with service Care Pathways

3. Attend regular MDT and divisional governance meetings (>70% per annum)

4. Annual appraisal of team members

5, Formal CPD with regular review to meet local CME requirements

6. Mandatory attendance at UG/PFDs ASM every 1-2 years

7. Participate in service development, pathway updates, audit (patient satisfaction)

Staff recruitment for service expansion and training:

Postgraduates:

1. Specialist trainees undertaking RCOG ATSM (1 year fellowship) UG

2. Recruit then to specialist post 2 years higher training (would include audit/

research component)

3.

Recruit consultants from in-house and overseas ‘trained pool’

4.

Midwives/CNS: Recruit in-house midwives/ staff nurses to train as continence

perineal/urodynamic specialists. Advancement and pay rise on completion if stay for

2 years minimum.

5. Attract undergraduates: Special Skills Modules in UG and PFDs

Capital costs equipment, maintenance, consumable costs, patient safety,

risk, staff training:

1. Outpatient flexible cystoscopy equipment

2. Urodynamics equipment

3. Anal physiology equipment

4. Ultrasound (trans-perineal, anal, trans-vaginal transducers)

5. MRI imaging

Lease equipment, replace and upgrade every 5 years, regular maintenance

(contracts), review consumables used and procurement costs regularly (includes

single use theatre devices), regular staff training updates, review equipment

related risk incidents, test protocols including sepsis, morbidity and patient safety.

Current and future challenges for Uro-Gynaecology services: 1. Consent 2. Information Governance (registries) 3. Providing

Current and future challenges for

Uro-Gynaecology services:

1. Consent

2. Information Governance (registries)

3. Providing patients with a range of treatment options

4. Managing patient expectations

5. Mesh complications

6. Training the next generation

Consent Uro-Gynaecology surgery: 1. Montgomery ruling 3. Consent form 4. Cooling off period 5. Patient

Consent Uro-Gynaecology surgery:

1. Montgomery ruling

3. Consent form

4. Cooling off period

5. Patient Information Leaflets (PILs)

6. Use of electronic records

7. Patient letters

8. Personal audit versus published audit patient data on

success failure and morbidity

9. Duty of candor

10. What medico-legally constitutes informed consent?

Mesh problems 1. Mesh inserted vaginally for stress urinary incontinence (e.g. TVT TOT) 2. Mesh

Mesh problems

1. Mesh inserted vaginally for stress urinary incontinence (e.g. TVT TOT)

2. Mesh inserted for prolapse correction vaginally

(e.g. apogee, prolift kits) 3. Abdominal insertion mesh (sacrocolpopexy)

Training the next generation: 1. Robust 1-year fellowships RCOG ATSM Uro-Gynaecology. 2. Competitive appointment two

Training the next generation:

1. Robust 1-year fellowships RCOG ATSM Uro-Gynaecology.

2. Competitive appointment two year fellowships for more

advanced training leading to an MSc for Uro-Gynaecology

or Uro-Obstetrics linked with UAE University Al Ain.

3. Fixed contracts for postgraduate training.

4. Medical students Special Skills Module (SSM) or

equivalent to stimulate interest and research in this area

(linked to the medical school).

5. Regular audit and annual research and study days.

6. Opportunities to work overseas for a fixed period.

Summary Mapping and monitoring the service: 1. Integrated Governance structures/processes 2. Good communication 3. Robust

Summary

Mapping and monitoring the service:

1. Integrated Governance structures/processes

2. Good communication

3. Robust IT

4. User friendly electronic records platform that is adaptable

and facilitates audit

5. Regularly updated interactive website

6. Involving patients in all aspects of their care and

incorporating their feedback into service changes and development.

Overview of proposed Corniche Hospital Uro-Gynaecology and Female Pelvic Floor Disorders service
Overview of
proposed
Corniche
Hospital
Uro-Gynaecology
and
Female Pelvic Floor
Disorders service
CEO Corniche Hospital Corniche Hospital Surgical Care: Ambulatory, Day Case, or inpatient, under local, regional
CEO Corniche
Hospital
Corniche Hospital Surgical Care: Ambulatory, Day
Case, or inpatient, under local, regional or general
anaesthesia (preferably dedicated anaesthetist team)
Follow-up at Corniche
Follow-up at Corniche

M Fynes iv.2018

Any Questions?
Any
Questions?
Any Questions?