A new haematuria pathway developed by the Whanganui MidCentral HealthPathways team helps GPs to identify patients at high risk of urothelial/urinary tract cancer and also facilitates faster specialist assessment. 

Blood in the urine, or haematuria, requires investigation. Palmerston North GP and HealthPathways Clinical Editor Andy Williams says haematuria is not uncommon. 

“If a patient comes in and says ‘I’ve got blood in my urine’, then we really need to follow up and find out where that blood is coming from because it can indicate disease and potentially cancer anywhere in the urinary tract from the kidneys to the urethra.” 

Whilst blood visible to the naked eye demands referral to a specialist, sometimes the blood is not so obvious and is only picked up at microscopic levels in a urine assessment. The guidelines around when and how to refer for microscopic haematuria were not clear for GPs in the Whanganui MidCentral District, so the local HealthPathways team worked with urologists to develop a new pathway. 

“It really came off the back of a prostate screening pathway I was developing with local urologists. We talked about haematuria, which has traditionally been managed by referring immediately to a specialist, and microscopic haematuria which had a less clear management strategy. We agreed both scenarios could be improved on, and the urologists were starting to use the new Cxbladder test and wanted it rolled out to primary care,” Dr Williams says. 

The Cxbladder test screens for early stages of cancer and has a very high accuracy. Introducing this test and providing GPs with clear guidelines on when and how to use it has reduced the number of specialist referrals in the region, says Dr Williams. 

“Available data indicates there has definitely been an uptick in pathway views, and fewer patients needing to be seen in hospital because they are being managed and screened out in primary care.”  

Left to right: Dr Andy Williams - General Practitioner and Health Pathways Clinical Editor, Sydney Street Health Centre, Palmerston North; Dr Christophe Chemasle - Consultant Urologist, Palmerston North Hospital

The new haematuria pathway developed by Dr Wiliams and local specialists provides GPs with guidelines on when and how to use the Cxbladder test to screen for early stages of cancer before referring the patient to specialist care. 

“The beauty of the process was that the HealthPathways programme team were able to facilitate the development of the pathway between the urology specialists and clinical editors on behalf of primary care. We also had good engagement from the radiology department and laboratory services and a firm that supplies the Cxbladder tests. So there was a multi-pronged approach between all the various parties and that was key to the success of the pathway.” 

Dr Wiliams is pleased there are now clear guidelines for management of both types of haematuria in primary care.  

“Investigation is instigated early and results obtained more quickly than the traditional model of care. At all stages there is improved continuity of care for the patient and greater satisfaction for both patient and clinician over the investigative phases,” he says. 

The lack of clear management strategy locally around the management of microscopic haematuria potentially led to the late presentation of significant disease. Both primary and secondary care services are now optimistic this can be avoided using the new pathway. 

“This pathway means that, when appropriate, we are able to refer with certainty so that the urologist can guarantee a prompt assessment of a patient. This provides greater security for the patient and reduces workload on the local urology department, and improves patient and clinician satisfaction. This has been borne out by positive feedback from affected patients, primary and secondary care clinicians and administration staff in both urology and radiology.” 

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