Female patients with lower limb fractures often experience pain and loss of dignity when manoeuvred onto a bedpan. Poor bladder management, including urinary catheterisation for convenience, can lead to longer hospital stays and eventual loss of independence. Disposable pulp male urinal bottles have been modified into a shape that accommodates the female perineum but they have not been used consistently, the design has varied depending on the fabricator and no formal evidence supported their use.

Using the Model for Improvement process with sequential Plan, Do, Study, Act (PDSA) cycles we formalised the design and spread the use of the urinal to other hospitals and an ambulance service. This project was inspired by a patient advocate of the “female” urinal.

A local feasibility study focussed on female patients with hip fracture in an emergency department and was followed by a second cycle in both emergency and trauma departments. The final cycle was a multi-institutional study*. The final study cohort was immobilised female patients (n=103) and healthcare professionals supporting them (n= 118). Utility was assessed by feedback on the advantages of the urinal. Healthcare professionals were also asked about impact on their working practices. Acceptability was addressed by asking patients and healthcare professional participants whether they would recommend the urinal.

Most patients and healthcare professionals in this trial would recommend the urinal to another patient. Patients felt they suffered less pain from movement and that it was a more dignified way to micturate. Healthcare professionals felt the advantages were potential to reduce the need for urinary catheters, for lifting and log rolling patients.

A disposable urinal that accommodates female anatomy and supplies the same advantages as the male urinal bottle (ability to micturate without the need for movement) would have value in many clinical settings.

What is already known on this topic – female patients with lower limb fractures suffer pain and indignity when being moved onto bed pans to micturate, men can use a male urinal bottle without being moved.

What this study adds – a female-specific urinal bottle is acceptable to both patients and healthcare staff, more dignified and less painful for patients and less work for healthcare staff.

How this study might affect research, practice or policy – a female-specific urinal bottle may reduce the use of urinary catheters for immobilised females with reduction in catheter-associated infections and loss of independence. It anticipated that it will reduce lifting by healthcare staff and reduce the number of staff required to assist patients.

The authors have declared no competing interest.

No funding was received for this project.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This project was undertaken as a service improvement project. Waiver of ethical approval for the first two cycles was confirmed by Dr. Donna Noonan, Head of Service, Research & Innovation, Great Western Hospitals NHS Foundation Trust. The multi-site, third cycle element of the project was approved by the Health Research Authority and Health and Care Research Wales (NHS) on 22nd March 2022 (IRAS project number 311131) with NHS Research Ethics Committee (22/PR/0191) (London-Harrow) approval. Participants gave informed consent to use the urinal and to provide anonymised feedback.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Funding: No funding was received for this project.

Competing interests: None declared

Patient and Public Involvement: Patients and/or public were not involved in the design, conduct, reporting or dissemination of this project.

Patient consent for publication: Not required.

Ethics approval: This project was undertaken as a service improvement project. Waiver of ethical approval for the first two cycles was confirmed by Dr. Donna Noonan, Head of Service, Research & Innovation, Great Western Hospitals NHS Foundation Trust. The multi-site, third cycle element of the project was approved by the Health Research Authority and Health and Care Research Wales (NHS) on 22nd March 2022 (IRAS project number 311131) with NHS Research Ethics Committee (22/PR/0191) (London-Harrow) approval. Participants gave informed consent to use the urinal and to provide anonymised feedback.

Data availability statement: Data are available on reasonable request. Requests to the corresponding author – Siân Thomas (sian.thomas9nhs.net). De-identified participant data can be made available on request.

Intellectual Property: Intellectual property is owned by Great Western Foundation Hospitals NHS Trust. Design protection is pending for this urinal. The name “EasyWee” has trade mark protection pending.

Data are available on reasonable request. Requests to the corresponding author, Siân Thomas (sian.thomas9atnhs.net). De-identified participant data can be made available on request.