ABSTRACT
Background: Urinary continence assessment and management plans are recommended in stroke clinical guidelines, however this care is often not provided. Aim: To determine the proportion of hospitalised patients with continence symptoms who have an assessment, diagnosis and management plan, before, and following the implementation of a practice change intervention. Methods: Fifteen wards (acute=3, rehabilitation=7, acute and rehabilitation= 5), that admit adult patients with stroke at 12 hospitals (metropolitan= 4, regional=8) participated. We implemented our evidence-based Structured urinary Continence Assessment and Management Plan (SCAMP) intervention (clinical decision tool, practice guidelines, webbased clinician education modules) using implementation strategies to overcome identified barriers. Screening and auditing of consecutive medical record for three 3-month periods were undertaken: before implementation (T0);after the 6-month implementation period (T1), and after a 6-month maintenance period (T2). The records of symptomatic inpatients were audited in detail. Descriptive statistics for The proportions of eligible symptomatic inpatients receiving continence assessment, diagnosis and management plans are presented. Results: All wards contributed data at T0, and 11/15 wards at T1 and T2. The onset of COVID19 prevented implementation at two rural wards, and two metropolitan wards closed immediately after implementation was completed. The proportion of symptomatic inpatients relative to all screened was: T0= 33% (283/849), T1= 33% (239/723), T2= 36% (247/695). The characteristics of symptomatic inpatients included: age(years) mean(SD) T0= 79(13), T1= 76(15), T2= 76(14);females T0= 57%(161/283);T1= 55%(132/239);T2= 58%(143/247). The proportions of symptomatic patients receiving components of care were: assessment within 72 hours T0= 38%, T1= 64%, T2= 64%;diagnosis T0= 30%, T1= 70%, T2= 72%;management plan T0= 7%, T1= 25%, T2= 23%. Discussion: From this large, multi-site study we identified implementation of our SCAMP intervention resulted in immediate improvements in continence care, that were sustained six months later. This intervention appears promising to increase access to best-practice continence care.
ABSTRACT
BACKGROUND: COVID-19, the illness caused by the novel coronavirus, SARS-CoV-2, has sickened millions and killed hundreds of thousands as of June 2020. New York City was affected gravely. Our hospital, a specialty orthopedic hospital unaccustomed to large volumes of patients with life-threatening respiratory infections, underwent rapid adaptation to care for COVID-19 patients in response to emergency surge conditions at neighboring hospitals. PURPOSES: We sought to determine the attributes, pharmacologic and other treatments, and clinical course in the cohort of patients with COVID-19 who were admitted to our hospital at the height of the pandemic in April 2020 in New York City. METHODS: We conducted a retrospective observational cohort study of all patients admitted between April 1 and April 21, 2020, who had a diagnosis of COVID-19. Data were gathered from the electronic health record and by manual chart abstraction. RESULTS: Of the 148 patients admitted with COVID-19 (mean age, 62 years), ten patients died. There were no deaths among non-critically ill patients transferred from other hospitals, while 26% of those with critical illness died. A subset of COVID-19 patients was admitted for orthopedic and medical conditions other than COVID-19, and some of these patients required intensive care and ventilatory support. CONCLUSION: Professional and organizational flexibility during pandemic conditions allowed a specialty orthopedic hospital to provide excellent care in a global public health emergency.