Improving Practice for Urinary Continence Care on Adult Acute Medical and Rehabilitation Wards: A Multi-Site, Co-Created Implementation Study

Many adult inpatients experience urinary continence issues; however, we lack evidence on effective interventions for inpatient continence care. We conducted a before and after implementation study. We implemented our guideline-based intervention using strategies targeting identified barriers and evaluated the impact on urinary continence care provided by inpatient clinicians. Fifteen wards (acute = 3, rehabilitation = 7, acute and rehabilitation = 5) at 12 hospitals (metropolitan = 4, regional = 8) participated. We screened 2298 consecutive adult medical records for evidence of urinary continence symptoms over three 3-month periods: before implementation (T(0): n = 849), after the 6-month implementation period (T(1): n = 740), and after a 6-month maintenance period (T(2): n = 709). The records of symptomatic inpatients were audited for continence assessment, diagnosis, and management plans. All wards contributed data at T(0), and 11/15 wards contributed at T(1) and T(2) (dropouts due to COVID-19). Approximately 26% of stroke, 33% acute medical, and 50% of rehabilitation inpatients were symptomatic. The proportions of symptomatic patients (T(0): n = 283, T(1): n = 241, T(2): n = 256) receiving recommended care were: assessment T(0) = 38%, T(1) = 63%, T(2) = 68%; diagnosis T(0) = 30%, T(1) = 70%, T(2) = 71%; management plan T(0) = 7%, T(1) = 24%, T(2) = 24%. Overall, there were 4-fold increased odds for receiving assessments and management plans and 6-fold greater odds for diagnosis. These improvements were sustained at T(2). This intervention has improved inpatient continence care.