Quality standard

Quality statement 7: Multidisciplinary team review before surgery or invasive treatment

Quality statement 7: Multidisciplinary team review before surgery or invasive treatment

Quality statement

Women with overactive bladder or stress urinary incontinence symptoms have a local multidisciplinary team review before surgery or other invasive treatment.

Rationale

Surgery or other invasive treatment should only be considered if conservative management and pharmacological treatment have been unsuccessful. Multidisciplinary team review can ensure that all other possible treatments have been considered before surgery and other invasive treatments. The whole team approach can also help the decision of whether invasive treatment is suitable for the woman.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that a local multidisciplinary team reviews the treatment options before surgery or other invasive treatment for women with overactive bladder or stress urinary incontinence.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service protocols.

Process

Proportion of women with overactive bladder or stress urinary incontinence who have a local multidisciplinary team review before surgery or other invasive treatment.

Numerator – the number in the denominator who had a local multidisciplinary team review before surgery or other invasive treatment.

Denominator – the number of women with overactive bladder or stress urinary incontinence who have surgery or other invasive treatment.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

What the quality statement means for different audiences

Service providers (such as community continence services and hospitals) ensure that local multidisciplinary teams are in place to discuss management strategies before surgery or other invasive treatment for women with overactive bladder or stress urinary incontinence.

Healthcare professionals ensure that women with overactive bladder or stress urinary incontinence have a local multidisciplinary team review before surgery or other invasive treatment.

Commissioners (such as integrated care systems and clinical commissioning groups) ensure that they commission services that carry out a local multidisciplinary team review before surgery or other invasive treatment for women with overactive bladder or urinary incontinence.

Women with leakage of urine caused by conditions called overactive bladder or stress urinary incontinence have a review of their condition by a team of healthcare professionals before surgery or other invasive treatment. This review will make sure that all other treatments have been considered and help with the decision of whether invasive treatment is right for the woman.

Definitions of terms used in this quality statement

Invasive treatments

These include:

  • botulinum toxin type A injection

  • percutaneous sacral nerve stimulation

  • augmentation cystoplasty

  • urinary diversion.

[Adapted from NICE's full guideline on urinary incontinence and pelvic organ prolapse in women (September 2013)]

Local multidisciplinary team

A multidisciplinary team for urinary incontinence that should include:

  • 2 consultants with expertise in managing urinary incontinence in women and/or pelvic organ prolapse

  • a urogynaecology, urology or continence specialist nurse

  • a pelvic floor specialist physiotherapist

    and may also include:

  • a member of the care of the elderly team

  • an occupational therapist

  • a colorectal surgeon.

[NICE's guideline on urinary incontinence and pelvic organ prolapse in women, recommendation 1.1.2]