Introducing a One Stop Haematuria Clinic and decarbonising the flexible cystoscopy tray

This project was completed as part of the Coventry and Warwickshire ICB Green Team Competition 2026. 

Team members:

Mercy Momoh, Assistant Urology Practitioner. 

Josh Hearne-Wilkins, Lead Urology Clinical Nurse Specialist. 

Joshua Mairafi, Assistant Urology Practitioner. 

Sophie Thomas, Urology Navigator. 

Setting / patent group: 

Patients referred to the haematuria pathway for investigation of visible or non-visible haematuria, at the urology department, University Hospitals Coventry and Warwickshire NHS Trust. 

Issue:

Patients referred through the traditional haematuria pathway often attended up to four separate hospital appointments for investigations, treatment, and results. This fragmented process contributed to delays in diagnosis, challenges in meeting Faster Diagnosis Standards, increased travel requirements, and additional stress for patients and carers. The pathway also generated unnecessary carbon emissions through repeated hospital journeys and the use of consumables associated with flexible cystoscopy procedures, including patient gowns, drapes, and large-volume saline irrigation bags. The combination of clinical inefficiency, environmental impact, and patient inconvenience provided an opportunity for sustainable service redesign.

Intervention: 

The team introduced a One Stop Haematuria Clinic, enabling clinically appropriate patients to undergo investigations and receive clinical decision-making within a single visit wherever possible. The pathway was redesigned to combine flexible cystoscopy, imaging, and selected treatments on the same day, reducing the number of hospital attendances required.

Alongside the pathway redesign, the project reduced the environmental impact of flexible cystoscopy procedures by removing unnecessary sterile drapes, reducing irrigation saline volumes from 1000 ml to 500 ml where appropriate, and allowing patients to wear their own clothing instead of hospital gowns. These changes were supported by staff engagement, patient education, governance review, and pilot testing to ensure patient safety and clinical effectiveness were maintained throughout implementation.

Outcomes:

Clinical

The introduction of the One Stop Haematuria Clinic improved the timeliness and coordination of care by reducing delays associated with multiple appointments. Patients were able to complete investigations more quickly, supporting earlier diagnosis and improved compliance with national cancer waiting time standards. Clinical safety was maintained throughout implementation, with no increase in complications or safety concerns identified. 

Environmental

The redesigned pathway reduced travel-related carbon emissions by approximately 6,681 kgCO₂e per year, representing a 50% reduction compared with the traditional pathway. Additional sustainability measures, including reducing saline usage, removing unnecessary drapes, and eliminating routine use of patient gowns, contributed a further reduction in emissions. Overall, the project is predicted to save approximately 7,098 kgCO₂e annually, demonstrating the significant environmental benefit that can be achieved through pathway redesign and sustainable clinical practice. 

Financial

The project generated substantial financial benefits without requiring significant capital investment. Reduced outpatient attendances produced the largest cost saving at £285,000, alongside efficiencies from lower consumable use and reduced cystoscopy tray requirements of £2,334. Collectively, the changes are estimated to deliver annual savings of approximately £287,344, while continuing to provide safe and effective patient care. 

Social

The project significantly reduced the burden of attending hospital appointments for patients and carers. Fewer visits reduced travel time, associated costs, and disruption to employment, caring responsibilities, and daily life. Patients expressed a strong preference for the one-stop model and reported reduced stress and uncertainty surrounding their diagnosis. The service also achieved an early reduction in DNA (Did Not Attend) rates from around 8% to 2%, suggesting improved accessibility and engagement. Staff reported improved workflow efficiency and a reduction in duplicated work, allowing more time to focus on direct patient care.

Key learning point 

This project demonstrated that sustainable quality improvement can simultaneously improve patient experience, clinical efficiency, environmental performance, and financial value. Success was underpinned by strong multidisciplinary collaboration, early stakeholder engagement, and a willingness to challenge established pathways and practices. The project also highlighted the importance of listening to both staff and patients throughout implementation, particularly when introducing changes to long-standing clinical routines. Maintaining flexibility, providing clear communication, and testing changes incrementally proved essential in overcoming resistance and achieving sustainable change. The results show that relatively simple service redesign can deliver substantial benefits for patients, staff, the organisation, and the environment while supporting NHS Net Zero ambitions.