Reducing waiting lists by converting a procedure from inpatient to outpatient

Intravesical Botox injection is recognised as an effective treatment for refractory overactive and neuropathic bladders. In 2020, amidst the COVID-19 pandemic, patients awaiting this procedure were placed in the least urgent category in terms of meeting the Treatment Time Guarantee of 12 weeks. NHS Lanarkshire Urology team reviewed their waiting lists in April 2021 and found that 52% of patients waiting for intravesical Botox had waited for more than 18 months. The Urology service seized this opportunity to streamline and redesign the service, and set out to convert patients from general anaesthetic (GA) to a local anaesthetic (LA) pathway. In doing this, they aimed to rapidly clear COVID-impacted patients from the waiting list and make sustainable changes that would keep waiting lists to a manageable size in the future.


The Urology service began by reviewing the waiting list and identifying patients who had requested GA during their procedure. These patients were then counselled on the alternative LA treatment option. Next, clinic and endoscopy staff received face-to-face training on how to provide intravesical Botox injections in an outpatient environment. The team identified 136 patients awaiting the procedure. Of these patients, 18 of them had previously received the treatment under GA. The team contacted these patients, alerted them to the long waiting list for GA procedures, and provided information about receiving the same treatment under LA.


Of the 18 patients contacted, 16 of them agreed to switch to an outpatient procedure with LA. 13 of those patients received their treatment in an outpatient setting within 12 weeks of referral, with the remaining patients delaying treatment due to urinary tract infection. The team has concluded that even patients who have regularly undergone Botox injections under GA are willing to switch to an LA procedure in an outpatient setting. After changing the pathway, the majority of Botox procedures are now performed in an outpatient setting. This has significantly reduced waiting times and also freed up theatre capacity. The Urology team feel this is a sustainable pathway change and have decided to adopt it permanently. You can view a poster the Urology team made about this project.