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.