Improving Practice for Urinary Continence Care on Adult Acute Medical and Rehabilitation Wards: A Multi-Site,...

Area of Science:

• Gerontology
• Geriatric Medicine
• Urology

Background:

• Urinary incontinence is a common issue for adult inpatients, yet effective interventions for inpatient continence care are not well-established.
• Lack of evidence hinders the implementation of optimal continence care strategies in hospital settings.

Purpose of the Study:

• To evaluate the impact of a guideline-based intervention on the quality of urinary continence care provided by inpatient clinicians.
• To assess improvements in continence assessment, diagnosis, and management plans for symptomatic adult inpatients.

Main Methods:

• A before and after implementation study was conducted across 15 hospital wards in 12 hospitals.
• A guideline-based intervention was implemented, targeting identified barriers to continence care.
• Medical records of adult inpatients were audited at three time points (before, during, and after implementation) to assess care quality.

Main Results:

• Symptomatic urinary incontinence affected approximately 26-50% of inpatients across different specialties (stroke, acute medical, rehabilitation).
• The proportion of symptomatic patients receiving recommended care significantly increased: assessment (38% to 68%), diagnosis (30% to 71%), and management plans (7% to 24%).
• There were 4-fold increased odds for receiving assessments and management plans, and 6-fold greater odds for diagnosis, with improvements sustained post-implementation.

Conclusions:

• The implemented guideline-based intervention effectively improved the quality of urinary continence care for adult inpatients.
• The observed improvements in assessment, diagnosis, and management were sustained over time, demonstrating the intervention's lasting impact.
• This study provides evidence for effective strategies to enhance continence care within hospital settings.