Ward AdmiSsion of Haematuria: an Observational mUlticentre sTudy
Conditions: Urologic Diseases, Hematuria, Hematuria; Benign, Bladder Cancer, Renal Cancer, Urothelial Carcinoma
Sponsor: British Urology Researchers in Surgical Training

1 
 
 
 
Title of study: 
Ward AdmiSsion of Haematuria: an Observational mUlticentre sTudy 
(WASHOUT) 
[Study Protocol] 
 
 
 
Protocol NCT number: 
Awaiting 
 
Version: 
V1.00 (Version for submission of peer review and protocol publication) 
 
 
Date uploaded to clinicaltrials.gov: 
19/03/2025 
 
 
 

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A study protocol on the Ward AdmiSsion of Haematuria: an Observational mUlticentre sTudy 
(WASHOUT) 
Nikita R.Bhatt and Kevin Byrnes (joint first), Simona Ippoliti, Raghav Varma, Bing Jie Chow, Quentin Mak, 
Nikki Kerdegari, Aqua Asif, Arjun Nathan, Alex Ng, Maria Ribal, John McGrath, Ben Lamb, Jim Catto, Ben 
Challacombe, Graeme Maclennan, Kevin Gallagher, Sinan Khadhouri, Veeru Kasivisvanathan 
 
Corresponding author: 
Veeru Kasivisvanathan, University College Hospital, University College London Hospitals NHS Foundation 
Trust, London, UK. 
veeru.kasi@ucl.ac.uk 
 
Keywords: emergency haematuria; inpatient haematuria; clot retention; collaborative study; radiation 
cystitis;  
Abstract 
Introduction 
Haematuria contributes significantly to emergency urology admissions. Despite over 25,000 annual UK 
admissions, with 10% readmitted within 30 days, there is limited focus on optimising inpatient pathways 
internationally. Existing studies highlight a substantial underlying malignancy rate (32%)  in patients 
presenting with visible haematuria, yet many receive inconsistent care, leading to prolonged hospital 
stays and increased resource use. A systematic review (PROSPERO CRD42023466710) performed by our 
research group found no large-scale prospective studies have been performed in this area, and little is 
known about current practice. This study aims to address these gaps by investigating current 
management practices and their impact on outcomes, with the goal of informing evidence-based 
guidelines and improving patient care. 
Methods and analysis  
The WASHOUT study is an international, multicentre prospective observational study designed to 
describe the management of patients with unplanned admission to hospital with haematuria. The study 
will utilise a collaborative methodology using the BURST  model.  Data on demographics, comorbidities, 
management practices, and outcomes will be collected using a standardised case report form and 
analysed using multilevel linear regression modelling. Primary outcomes include length of stay, while 
secondary outcomes cover diagnosis time, 90-day mortality, readmission rates, and resource use. 
Patient and public involvement has been integral to the study design, ensuring that outcomes reflect 
patient priorities and that the research addresses key areas of concern. 
Ethics and dissemination  
Ethical and regulatory approvals will be obtained as required in each participating region. In the UK, the 

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study is classified as a service evaluation and does not require individual patient consent. Participating 
sites must obtain local audit department approval. Data will be collected and stored securely, ensuring 
patient confidentiality. Results will be disseminated through scientific conferences, peer-reviewed 
publications, and patient advocacy groups.  
Strengths and Limitations 
1. The large international, multicentre prospective study design captures real-world clinical 
practice, enhancing the generalizability of findings due to the diversity of data. 
2. Broad inclusion and exclusion criteria ensure the study captures a wide variety of haematuria 
presentations, enabling comprehensive analysis and robust subgroup analysis. 
3. The collaborative model of data collection, proven successful in previous studies, ensures high-
quality, standardized data and sufficient power through large patient recruitment. 
4. Patient and public involvement in the study design ensures that the research addresses relevant 
clinical outcomes and aligns with patient priorities, increasing the relevance and impact of the 
findings. 
5. Limitations include variability in data quality across different sites, the lack of a standardized 
workup and management pathway, and the observational design, which limits the ability to 
establish causality. 
 
 

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Introduction 
Over 25,000 patients are admitted each year in the UK with haematuria, contributing to at least 15% of 
all emergency urology admissions [1,2]. Up to 10% of these patients are readmitted with the same 
presentation within 30 days — patients frequently lack a durable treatment response or do not receive 
definitive diagnosis or management on initial presentation [2].  Despite the prevalence of this 
presentation, little focus has been placed on optimising inpatient pathways at a national level and 
reducing unnecessary resource use.  
Findings from the prospective The Investigation and Detection of urological Neoplasia in paTIents 
referred with suspected urinary tract cancer: A multicentre analysis (IDENTIFY) study (by the BURST 
research collaborative) of 11,059 patients showed that 32% of patients presenting with visible 
haematuria had an underlying malignancy [3]. Of the remaining cohort, 40% had benign aetiology (e.g. 
comprising one or more of: urinary tract infections (28%), urolithiasis (25%), prostatic bleeding (37%), 
radiation cystitis (55%) and trauma (3%). 28% had no abnormality on investigation. Similar findings were 
reported by two further authors: a third of the patients presenting as an emergency with haematuria 
had malignancy with the rate increasing in patients with clots, while a malignancy rate of 39% was 
reported in a French study in patients presenting an emergency with haematuria [4,5]. More advanced 
bladder tumours are more likely to present as emergencies. In National Cancer Registration and Analysis 
Service (NCRAS) data, the rates of emergency admission for bladder cancer increased from T1 (7%) and 
T2/3 (16-19%) to T4 (31%) [6]. Patients in this cohort are typically elderly and frail, with multiple 
comorbidities and poor performance status. This cohort of patients has a high all-cause mortality rate, 
with a 30-day mortality rate of 5% and a one-year mortality rate of 23% [2]. Severe haematuria is often 
complicated by concomitant comorbidities such as cardiac failure, renal failure, history of 
thromboembolic events, and use of antiplatelet or anticoagulant medications [7].  
In addition to poor clinical outcomes, patients admitted with haematuria require a higher resource use 
in terms of nursing and medical input, irrigation requirements, long inpatient stays and high readmission 
rates. A recent retrospective study (of 56 patients) in Ireland examining resource use associated with 
radiation cystitis conservatively estimated a cost burden of €23,706 per inpatient stay [8]. Radiation 
cystitis accounted for 621 inpatient bed days, averaging 11 days per patient. A small minority of patients 
are resource-intensive, some being transfusion-dependent with long inpatient stays and multiple 
procedures. The median length of stay for patients admitted with haematuria has increased from 8.5 
days to 10 days over the last 5 years [9]. The reason behind this trend is currently unknown. This trend is 
the reverse of contemporary management goals such as length of stay in elective urological surgery (e.g. 
TURP/TURBT), for which a move toward day-case surgery (and same day of surgery discharge) has 
reduced unnecessary inpatient days in patients with postoperative haematuria [10].  
Components of an effective inpatient haematuria pathway could potentially include specialist urology 
input at the point of presentation (to perform catheterisation and washout), timely imaging studies, 
theatre staff competent in supporting endoscopic urology, decisive intervention, consultant involvement 

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in operative management, acceptance of operative risk, and the avoidance of deferral to elective lists 
for definitive management. However, these elements of a haematuria pathway remain to be be 
investigated. It remains unclear which elements of management pathways are associated with best 
outcomes. There is a need to protocolise inpatient haematuria management in line with 
recommendations in other areas by Getting it Right First Time (GIRFT) national programmes. 
A systematic review (PROSPERO CRD42023466710) performed by our research group found no large-
scale prospective studies have been performed in this area, and little is known about current practice. 
Several fundamental questions about variation in practice across the UK and internationally remain 
unanswered including: i) What proportion of patients have a known underlying urological diagnosis? ii) 
What proportion of patients receive a new definitive diagnosis on index admission? iii) What proportion 
of patients undergo intervention during the admission? iv) Is early intervention associated with lower 
resource use or decreased readmission rates? v) What is the all-cause mortality in this patient cohort? 
vi) What proportion of patients are deemed palliative during their initial admission? vii) What proportion 
of patients are readmitted with the same issue? Answering these questions is essential to informing 
areas of best practice in this area as well as creating future research priorities for prevention and 
management of haematuria. The evidence available comprises small-single centre retrospective audits 
[2,8] evaluating mortality, readmission and cost burden of this presentation.  
There are no evidence-based guideline recommendations on the timing of investigations and 
interventions for inpatients with haematuria. Consequently, the management of visible haematuria is 
currently suspected to be highly variable, both nationally and internationally but further evidence is 
necessary to substantiate this. Clear guidelines and standardised management pathways may reduce 
variability in the management of these patients. There is an urgent need to provide good quality 
evidence in this under-researched area to potentially improve outcomes.  
 
Methods and analysis 
Study design and aim 
WASHOUT is an international, multicentre prospective observational study aiming to describe the 
management of patients with unplanned admission to hospital with haematuria.  
Objectives: 
Our objectives are: 
- 
Establish the prevalence of causative diagnoses in patients with unplanned admission to hospital 
because of haematuria.  
- 
Describe demographics, comorbidities, management, and clinical outcomes of patients with 
unplanned admission to hospital because of haematuria.  
- 
Identify factors associated with adverse outcomes and/or increased resource use in this 
population. 

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- 
Identify if variation in management and outcomes exists at local, regional and international 
levels. 
- 
Describe the impact different management pathways have on clinical outcomes (in terms of 
length of stay, health resource utilisation, readmission, 30-day and 90-day mortality rates. 
- 
Provide information to design a future randomised trial, for example control group outcomes 
and estimates of inter-cluster correlations. 
 
Hypothesis 
The study hypothesis is that there is significant international and national variation in the diagnostic 
workup and management of patients requiring admission to hospital with haematuria.  
Increased length of stay and poor outcomes in terms of mortality and healthcare costs are associated 
with clinical management practices. 
Eligibility 
Patient Inclusion criteria 
Patients will be included consecutively if they are over 18 years of age and have an unplanned admission 
to a participating secondary care centre under the primary or joint care of the urology team due to 
haematuria.  
In the UK, individual consent is not necessary as this study has been considered a service evaluation.  
Patient Exclusion criteria 
We will exclude any patients with trauma as a cause of haematuria (including catheter related trauma: 
defined as haematuria immediately after insertion of a urethral catheter without a preceding history of 
haematuria on this admission including traumatic catheter removal by patients), urological trauma 
(abdominal/pelvic) as well as patients who are in hospital less than 24 hours. Our study steering group 
felt this population had several confounders, including inappropriate admissions. Including these 
patients would mix the study population with patients best served by outpatient investigation and 
management (for which guidelines currently exist to guide practice) 
Site inclusion criteria 
Secondary care centre with a urology-specific unit/ team that accepts unplanned admissions anywhere 
in the world.  
Site exclusion criteria 
Sites lacking a minimum standard of data quality and completion will be excluded  

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Outcomes 
As WP1 lacks an experimental design; it is not powered to a specific primary outcome. However, to 
emulate outcomes of interest for a target trial in WP3 we identified primary and secondary outcomes 
with public and patient involvement.  
Primary outcome 
Length of stay (LoS), measured in calendar days. A basic definition of LoS is the number of days 
measured as an integer by taking the date of admission in the index hospital admission episode and the 
date of discharge from the hospital, and calculating the date difference between them. Variations in 
exact definitions of length of stay will be reported. Examples of this are including calendar days spent in 
the emergency department, or excluding days after care of the patient is taken over by another team, or 
after being medically discharged. 
 
Secondary outcomes 
- 
For those without a previously known cause of haematuria: time to definitive diagnosis, defined 
as the number of days between original presentation and final diagnosis.  
- 
Length of time required to be in hospital for hospital, measured as an integer by taking the date 
of admission in the index hospital admission episode and the date of discharge from the hospital 
or the date deemed medically fit for discharge (whichever is first), and calculating the date 
difference between them.  
- 
90-day mortality rate measured as the proportion of patients who died from the day of 
admission to the 90-day follow-up period.  
- 
90-day readmission rate, measured as the proportion of patients who were readmitted to the 
hospital with the same issue in the 90-day after the date of discharge.  
- 
Number of days alive and out of hospital at 90 days.  
- 
Resource use, including inpatient days and investigations and procedures that the patient 
underwent during the admission and in the 90-day follow-up period. 
- 
The study will also assess current pathways that exist in hospitals, including acute care pathways 
and specific pathways for management of haematuria. Details will be obtained through a 
questionnaire distributed to each participating site. 
 
Sub-group analysis  
 
- 
Plan to report outcomes of study for the following diagnostic sub-groups: 
- 
Radiation cystitis  
- 
Urological malignancy (including pre-existing and new diagnoses) 
- 
Unknown diagnosis at presentation 
Study setting  

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This study will take place in urological secondary and tertiary care centres internationally. The study will 
be conducted in centres that agree to participate in the study and meet the study's inclusion criteria 
below.  
Study delivery  
 
The study will utilise the The British Urology Researchers in Surgical Training (BURST) collaborative 
model which has been previously applied to observational studies globally [11]. In IDENTIFY, we 
recruited 11,029 patients to a multicenter observational study [3]. RESECT an observational, 
international, multicenter study with an embedded cluster randomised trial of audit, feedback, and 
education and recruited 19,500 cases[12]. The design of the current study has been supported by input 
from the Centre for Healthcare Randomised Trials (CHaRT) (i.e. The Urology Foundation trials unit), who 
will be involved in designing and conducting the next study, which we anticipate will be an 
implementation randomised controlled trial. 
Recruitment 
Patients will be recruited consecutively. The recruitment target for this study is based pragmatically on 
the prevalence of inpatient haematuria. Target recruitment per participating site is 15 patients across a 
12-month period from 70 centres. The cumulative recruitment target from all sites is 1,050 patients. We 
want to recruit as many participants as possible during the 12-month period. The sample size is also 
based on the anticipated wide variation of practice and the heterogeneous nature of the presentation in 
terms of patient demographics and the underlying cause of the haematuria ranging from benign causes 
to malignant urological conditions [1, 2].  
This sample size is also adequately powered to detect a meaningful difference in length of stay (defined 
as at least 1 day by study authors) using ANOVA to analyse any binary variable (spanning both 
clinicopathological features and management factors). This 1-day difference in length of stay is based on 
a calculated sample size of 1,054 patients, obtaining a power of 0.90 with a significance level of 0.05, 
and taking a standard deviation of length of stay as 5 days obtained from original data of a retrospective 
review covering this study population [2]. 
Data collection 
Participating sites will complete a registration survey describing their institution and urological practice 
(sub-specialities and consultants, on-call rota and support) and if any local protocols or defined criteria 
for referral/admission exist - Appendix 2).  
Data will be collected prospectively on consecutive patients requiring emergency admission over a 12-
month period. Non-identifiable patient data will be collected by individual investigators using the 
REDCap electronic data capture tool. Data will be collected prospectively by the participating centres 
using a standardised case report form (CRF). The CRF will include data on demographics, medical history, 
aetiology of haematuria, length of stay, investigations, interventions, complications, health resource 
utilisation, readmissions, and 30-day and 90-day mortality rates. Data will also be collected on 

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interventions (if any) including ward management, surgical, radiological and any other interventions or 
adjunct treatments. Data collected is information recorded as part of clinical assessment, thereby 
allowing local sites to qualify as a process evaluation in the UK setting. Further details are available in 
Appendix 1 and 2.  
Data will be entered into a secure online UCL Redcap database. All data collected will be kept 
confidential and anonymous. Each participating centre will be assigned a unique identifier code, and no 
personal identifying information will be collected from the patient or managing surgeon. Where 
available, standardised clinical data models will be used to structure data collection. We will ensure each 
site has registered with the relevant local audit department that they are undertaking an evaluation of 
current practice.  
Data analysis  
We will describe the cohort demographic and clinical variables at baseline, using descriptive statistics.  
 
We will use multilevel linear regression modelling to analyse primary outcome length of stay (LoS) to 
understand the variation across centres, extending this to model the association between LoS and 
factors such as age, gender, comorbidities, and management practices. Missing data will be handled 
using multiple imputation and pattern mixture models. Secondary outcomes will be analysed similarly 
using the appropriate multilevel generalised linear model for the distribution of the outcome. 
 
Descriptive resource use information will be presented according to standard categories, and standard 
unit costs (NHS Reference Costs) applied where appropriate to provide information on costs of the 
observed patient diagnostic and therapeutic pathways. 
Patients who do not complete follow-up period 
Investigators who enter a follow-up period earlier than 90 days will be included in the analysis for the 
outcomes of length of stay, readmission and mortality. Resource use will be included if entered in the 15 
days prior to 90 day follow-up or any point after.  
Ethics and dissemination 
Before beginning the study, ethical and local regulatory approval as required in each respective region, 
will be obtained in accordance with applicable guidelines. In the UK, the Health Research Authority and 
the National Research Ethics Service advised that this study was exempt from ethical approval. The 
letter supporting this is attached as Appendix 3. Each participating UK site will require approval from 
their local audit department and/or research and development office. The international sites will be 
provided with study documentation to apply for local ethics approval.  
Once the study is complete, the results will be presented at international scientific conferences in the 
field of urology, published in peer-reviewed journals, and shared with patient advocacy groups via 
Urology charities, including the Urology Foundation (TUF), the European Association of Urology patient 

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office and our patient and public involvement (PPI) panel. We are committed to ensuring that all 
collaborators who make significant contributions to the study will be listed as collaborative authors on 
Pubmed-indexed papers resulting from the study as per the BURST authorship policy used in previous 
BURST projects [9].  We will communicate findings to leading associations, including NICE and EAU. We 
will also disseminate research findings using different (social) media platforms. 
Quality control  
An independent quality control team will thoroughly check all data submitted to ensure accuracy and 
completeness. Incomplete or outlier data will be identified, and investigators will be contacted to 
address any issues. 
Patient Public Involvement  
A total of 10-15 patients who have been admitted with haematuria were identified by directly 
contacting patients admitted to hospital with this condition, marketing through social media and patient 
focus groups as well as charities. Anyone with a personal experience of blood in their urine requiring 
hospital admission or a relative or friend of a patient suffering from this condition was eligible as a 
patient representative. Public representatives could include lay members of the public with an interest 
in patient improvement research. Ethics was not necessary as this was deemed as involvement work and 
feedback on study design was collected rather than any study data. They were invited to a virtual 
meeting on Zoom to explore outcomes of interest, aspects of care that they deem important, and 
identify areas of satisfaction or dissatisfaction within the management pathway. The PPI panel were 
remunerated for their time and input.  
During the first PPI group meeting, a BURST committee member introduced the study, providing an 
overview of its objectives and expected outcomes. The meeting was coordinated by a PPI facilitator 
based in the University College of London (UCL). Participants shared their personal experiences with 
haematuria, discussing symptoms, diagnosis, and the impact on their lives. Patients were briefed on the 
study's objectives, design, and research methods, seeking their input on study parameters via an open 
discussion during the meeting and via a 10-item questionnaire sent via email. Patients and researchers 
reviewed the potential benefits and risks of the study, highlighting any concerns or suggestions. 
The focus group agreed that: 
➢ The study is both valuable and they would prefer a standardised pathway for haematuria 
management following emergency hospital admission 
➢ No concerns were expressed regarding the study 
➢ The study primary and secondary outcomes (e.g.: length of hospital admission, 30-day and 3-
month mortality rate, readmission rate and resource utilisation) are important to patients  
➢ Care should be taken to create a standardised pathway which includes a prompt management 
of the patients when presenting symptoms of clot retention in the emergency department or in 
the community (e.g.: by promoting fast-track to specialty or access to adequate points of care).  

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➢ As a result of PPI involvement, changes have been made to the case report form on aspects of 
ward management as patients felt this was important. Specifically, they expressed getting 
prompt access to catheterisation, washouts and irrigation was important. 
 
References: 
[1]     Hospital Episode Statistics, Hospital Admitted Patient Care Activity. NHS Digital. 
2022.https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/hospital-
episode-statistics (accessed January 1, 2022). 
 [2]       Pavithran A, Bhatt NR, Banerjee G, Hawizy A. Management of Inpatient Macroscopic Haematuria: 
A Typical Urology Emergency with a High Mortality. Urology 2022;166:22–8. 
[3]        Khadhouri S, Gallagher KM, MacKenzie KR, Shah TT, Gao C, Moore S, et al. The IDENTIFY Study: 
The Investigation and Detection of Urological Neoplasia in Patients Referred with Suspected Urinary 
Tract Cancer; A multicentre observational study 2021. 
[4]  
Gan J, Harris A, Green J. Quantifying the risk of malignancy in patients with visible haematuria 
presenting to the emergency department. Journal of Clinical Urology. 2015;8(2):132-138. 
doi:10.1177/2051415814548913 
[5]  
Errando Smet C, Martinez De Hurtado J, Regalado Pareja R, Huguet Pérez J, Montlleó Gonzalez 
M, López Duesa L, Bakali Mourabet K, Chéchile Toniolo G, Vicente Rodriguez J. Analyse de 895 
consultations pour hématurie dans le département des urgences d'un service d'urologie [Analysis of 895 
consultations for hematuria in the emergency department in an urology unit]. J Urol (Paris). 
1996;102(4):168-71. French. PMID: 9091567. 
[6]  
Catto JWF, Mandrik O, Quayle LA, Hussain SA, McGrath J, Cresswell, J, Birtle AJ, Jones RJ, 
Mariappan P, Makaroff LE, Knight A, Mostafid H, Chilcott J, Sasieni P, Cumberbatch M. Diagnosis, 
treatment and survival from bladder, upper urinary tract, and urethral cancers: real-world findings from 
NHS England between 2013 and 2019. BJU Int. 2023 Jun;131(6):734-744. doi: 10.1111/bju.15970. Epub 
2023 Feb 7. PMID: 36680312. 
 [7] 
 Satasivam P, Reeves F, Lin M, Daruwalla J, Casan J, Lim C, et al. The effect of oral 
anticoagulation on the prevalence and management of haematuria in a contemporary Australian patient 
cohort. BJU Int 2012;110:80–4. 
[8]       Gilmartin B, O’ Meara SO, D’arcy FTD, Dowling CMD. A0083 - Cost burden of radiation cystitis 
presentations and investigations to a tertiary referral hospital in Ireland. Eur Urol 2023;83:S122. 
https://doi.org/https://doi.org/10.1016/S0302-2838(23)00140-9. 
[9] 
NHSE. GIRFT All Clinical Metrics [Internet]. Model Health System Website. 2023 [cited 2023 Apr 
18]. Available from: https://model.nhs.uk/home 
[10]       Gray WK, Day J, Briggs TWR, Harrison S. Transurethral resection of bladder tumour as day-case 
surgery: Evidence of effectiveness from the UK Getting it Right First Time (GIRFT) programme. J Clin Urol 
2020;13:221–7. 
[11]       Kasivisvanathan V, Ahmed H, Cashman S, Challacombe B, Emberton M, Gao C, et al. The British 
Urology Researchers in Surgical Training (BURST) Research Collaborative: an alternative research model 
for carrying out large scale multi-centre urological studies. BJU Int 2018;121. 
https://doi.org/10.1111/bju.14040. 

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[12]       Wang B, Gallagher K, Bhatt N, Clement K, Zimmermann E, Khadhouri S, et al. MP08-10 GLOBAL 
VARIATION IN EARLY RECURRENCE AFTER TRANSURETHRAL RESECTION OF BLADDER TUMOR IN THE 
RESECT STUDY (NCT05154084): THERE IS SIGNIFICANT INTER-SITE VARIATION THAT IS INDEPENDENT OF 
DIFFERENCES IN TUMOUR FACTORS. J Urol 2023;209:e97. 
 
 
Author contributions  
Study concept: NB, KB and VK  
Study design: NB, KB, SK, KG, GM, VK 
Protocol writing: NB, KB  
Protocol editing and revisions: NB, KB, VK, GM, SI, RV, NK, BC, QM, AN, AA, ANg, SK, KG, GM, MR, BC, 
JM, JC, BL.  
 
 
Funding: 
This work was supported by  
The Urology Foundation & The Charles Reynolds Foundation - Innovation and Research Award 2024 
(awarded 24 May 2024) 
Action Bladder Cancer UK - Improving Outcomes for Patients Programme 2024 (awarded 29 May 2024) 
 
 
 
 
 
Appendix 1: Variables to be collected on each patient (to be discussed with PPI group and 
finalised) 
Patient factors  
- 
Baseline demographic information including age, gender 
- 
ASA grade 
- 
Frailty index 
- 
Antithrombotic agents (anticoagulants and antiplatelets) 
- 
Smoking history 
- 
Previous radiation 
- 
Details of clinical history 
- 
Previous urological history 
Haematuria factors 

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- 
Reason for referral / clinical presentations of haematuria (haematuria / clot retention, pain, 
dysuria/cystitis, pyelonephritis/urosepsis, upper tract obstruction, re-presentation/re-admission to 
ED within 30 days) 
- 
Use of blood products or reversal agents  
- 
Use of antibiotics  
- 
Tranexamic acid 
- 
Transfusion rates 
- 
Examination findings/ Initial Observations / Sepsis- DRE  
- 
Urine microscopy results 
- 
Blood test results during admission e.g. AKI, low Hb, coagulation issues  
- 
Imaging timing and results during admission  
- 
Ward based management during admission for example catheterisation, washout, irrigation  
- 
Level of ward care (Intensive Treatment Unit/High Dependency Unit/Ward) 
- 
Procedure results during admission e.g. rigid cystoscopy and washout, TURBT etc 
- 
Grade of operating surgeon  
- 
Findings at procedure  
- 
Complications of procedure performed  
- 
Length of stay  
- 
Palliative care involvement  
- 
Healthcare resource use (imaging studies performed, procedures performed) 
Disease factors  
- 
Underlying aetiology 
- 
Number of previous admissions for the same reason 
- 
Readmission rate over 30 days and 90-days 
- 
 30-day and 90-day mortality rate  
- 
VTE; rate of DVT/PE 
 
 
Appendix 2. Information from centres regarding current management of unscheduled haematuria 
admissions 
1. 
 Does your unit have a protocol for inpatient management of haematuria? 
2. Are there defined admission criteria for patients presenting with visible haematuria? If so, 
please define these.  
3. Describing the type of institution (district general hospital versus tertiary university hospital, 
academic centre/ 
4. Describe urological practice of consultants (sub-specialities and consultants) 
5. Is the site split into emergency and elective sites? 
6. How is care delivered/structured (who receives referrals - consultant or registrar led on-call)? 

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7. Do you have bedside flexible cystoscopy available?  
8. Is there a dedicated urology treatment room contained within the acute care component of 
your hospital (is it staffed by CNSs, equipment available, protocols defined). 
9.  Ward rounds led by registrar/consultant 
10. Do you have access to same day imaging - leave free text as well  
11. Do you have access to dedicated CEPOD facilities 
12. Do you have interventional radiology on-site 
13. Is the primary on-call team free from elective commitments on-call 
14. Grade of clinician accepting urology referrals during the day (consultant, reg, SHO, ANP/CNS) 
15. Grade of clinician accepting urology referrals overnight (consultant, reg, SHO, ANP/CNS) 
16. Do you have access to a one-stop haematuria clinic for investigating patients with haematuria?