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Marsden DL, Boyle K, Birnie J, Buzio A, Dizon J, Dunne J, Greensill S, Hill K, Lever S, Minett F, Ormond S, Shipp J, Steel J, Styles A, Wiggers J, Cadilhac DAM, Duff J. Improving Practice for Urinary Continence Care on Adult Acute Medical and Rehabilitation Wards: A Multi-Site, Co-Created Implementation Study. Healthcare (Basel) 2023; 11:healthcare11091241. [PMID: 37174783 PMCID: PMC10178438 DOI: 10.3390/healthcare11091241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
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 (T0: n = 849), after the 6-month implementation period (T1: n = 740), and after a 6-month maintenance period (T2: n = 709). The records of symptomatic inpatients were audited for continence assessment, diagnosis, and management plans. All wards contributed data at T0, and 11/15 wards contributed at T1 and T2 (dropouts due to COVID-19). Approximately 26% of stroke, 33% acute medical, and 50% of rehabilitation inpatients were symptomatic. The proportions of symptomatic patients (T0: n = 283, T1: n = 241, T2: n = 256) receiving recommended care were: assessment T0 = 38%, T1 = 63%, T2 = 68%; diagnosis T0 = 30%, T1 = 70%, T2 = 71%; management plan T0 = 7%, T1 = 24%, T2 = 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 T2. This intervention has improved inpatient continence care.
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Affiliation(s)
- Dianne Lesley Marsden
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Kerry Boyle
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Belmont Hospital, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
| | - Jaclyn Birnie
- Armidale Hospital, Hunter New England Local Health District, Armidale, NSW 2350, Australia
| | - Amanda Buzio
- Coffs Harbour Health Campus, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia
| | - Joshua Dizon
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Judith Dunne
- Rankin Park Centre, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
- John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
| | - Sandra Greensill
- Rockhampton Hospital, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
| | - Kelvin Hill
- Stroke Foundation, Melbourne, VIC 3000, Australia
| | - Sandra Lever
- Ryde Hospital, Northern Sydney Local Health District, Eastwood, NSW 2122, Australia
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW 2006, Australia
| | - Fiona Minett
- Manning Hospital, Hunter New England Local Health District, Taree, NSW 2430, Australia
- Wingham Hospital, Hunter New England Local Health District, Wingham, NSW 2429, Australia
| | - Sally Ormond
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
- Calvary Mater Newcastle, Waratah, NSW 2298, Australia
| | - Jodi Shipp
- Rankin Park Centre, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
- John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
| | - Jennifer Steel
- Port Macquarie Hospital, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia
| | - Amanda Styles
- Armidale Hospital, Hunter New England Local Health District, Armidale, NSW 2350, Australia
- Tamworth Hospital, Hunter New England Local Health District, Tamworth, NSW 2340, Australia
| | - John Wiggers
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Health Research and Translation, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
| | - Dominique Ann-Michele Cadilhac
- Stroke and Ageing Research, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences at Monash Health, Clayton, VIC 3168, Australia
| | - Jed Duff
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4001, Australia
- Royal Brisbane and Womens Hospital, Queensland Health, Brisbane, QLD 4029, Australia
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Garcia-Esperon C, Chew BLA, Minett F, Cheah J, Rutherford J, Wilsmore B, Parsons MW, Levi CR, Spratt NJ. Impact of an outpatient telestroke clinic on management of rural stroke patients. Aust J Rural Health 2022; 30:337-342. [PMID: 35412702 DOI: 10.1111/ajr.12849] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Report on feasibility, use and effects on investigations and treatment of a neurologist-supported stroke clinic in rural Australia. DESIGN Data were collected prospectively for consecutive patients referred to atelehealth stroke clinic from November 2018 to August 2021. SETTINGS, PARTICIPANTS AND INTERVENTIONS Patients attended the local hospital, with a rural stroke care coordinator, and were assessed by stroke neurologist over videoconference. MAIN OUTCOME MEASURES The following feasibility outcomes on the first appointments were analysed: (1) utility (a) change in medication, (b) request of additional investigations, (c) enrolment/offering clinical trials or d) other; (2) acceptability (attendance rate); and (3) process of care (waiting time to first appointment, distance travelled). RESULTS During the study period, 173 appointments were made; 125 (73.5%) were first appointments. The median age was 70 [63-79] years, and 69 patients were male. A diagnosis of stroke or transient ischemic attack was made by the neurologist in 106 patients. A change in diagnosis was made in 23 (18.4%) patients. Of the first appointments, 102 (81.6%) resulted in at least one intervention: medication was changed in 67 (53.6%) patients, additional investigations requested in 72 (57.6%), 15 patients (12%) were referred to a clinical trial, and other interventions were made in 23 patients. The overall attendance rate of booked appointments was high. The median waiting time and distance travelled (round-trip) for a first appointment were 38 [24-53] days and 60.8 [25.6-76.6] km respectively. CONCLUSION The telestroke clinic was very well attended, and it led to high volume of interventions in rural stroke patients.
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Affiliation(s)
- Carlos Garcia-Esperon
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Beng Lim Alvin Chew
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Fiona Minett
- Department of Nursing Administration, Manning Base Hospital, Taree, New South Wales, Australia
| | - Joseph Cheah
- Department of Nursing Administration, Manning Base Hospital, Taree, New South Wales, Australia
| | - Jennifer Rutherford
- Hunter New England Information and Communications Technology, Telehealth, Newcastle, New South Wales, Australia
| | - Bradley Wilsmore
- Department of Cardiology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Mark W Parsons
- College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Department of Neurology, Ingham Institute for Applied Medical Research, Liverpool Hospital, University of New South Wales South Western Sydney Clinical School, Sydney, New South Wales, Australia
| | - Christopher R Levi
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Neil J Spratt
- Department of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.,College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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Marsden DL, Boyle K, Jordan LA, Dunne JA, Shipp J, Minett F, Styles A, Birnie J, Ormond S, Parrey K, Buzio A, Lever S, Paul M, Hill K, Pollack MRP, Wiggers J, Oldmeadow C, Cadilhac DAM, Duff J. Improving Assessment, Diagnosis, and Management of Urinary Incontinence and Lower Urinary Tract Symptoms on Acute and Rehabilitation Wards That Admit Adult Patients: Protocol for a Before-and-After Implementation Study. JMIR Res Protoc 2021; 10:e22902. [PMID: 33538703 PMCID: PMC7892286 DOI: 10.2196/22902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/19/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background Urinary incontinence (UI) and lower urinary tract symptoms (LUTS) are commonly experienced by adult patients in hospitals (inpatients). Although peak bodies recommend that health services have systems for optimal UI and LUTS care, they are often not delivered. For example, results from the 2017 Australian National Stroke Audit Acute Services indicated that of the one-third of acute stroke inpatients with UI, only 18% received a management plan. In the 2018 Australian National Stroke Audit Rehabilitation Services, half of the 41% of patients with UI received a management plan. There is little reporting of effective inpatient interventions to systematically deliver optimal UI/LUTS care. Objective This study aims to determine whether our UI/LUTS practice-change package is feasible and effective for delivering optimal UI/LUTS care in an inpatient setting. The package includes our intervention that has been synthesized from the best-available evidence on UI/LUTS care and a theoretically informed implementation strategy targeting identified barriers and enablers. The package is targeted at clinicians working in the participating wards. Methods This is a pragmatic, real-world, before- and after-implementation study conducted at 12 hospitals (15 wards: 7/15, 47% metropolitan, 8/15, 53% regional) in Australia. Data will be collected at 3 time points: before implementation (T0), immediately after the 6-month implementation period (T1), and again after a 6-month maintenance period (T2). We will undertake medical record audits to determine any change in the proportion of inpatients receiving optimal UI/LUTS care, including assessment, diagnosis, and management plans. Potential economic implications (cost and consequences) for hospitals implementing our intervention will be determined. Results This study was approved by the Hunter New England Human Research Ethics Committee (HNEHREC Reference No. 18/10/17/4.02). Preimplementation data collection (T0) was completed in March 2020. As of November 2020, 87% (13/15) wards have completed implementation and are undertaking postimplementation data collection (T1). Conclusions Our practice-change package is designed to reduce the current inpatient UI/LUTS evidence-based practice gap, such as those identified through national stroke audits. This study has been designed to provide clinicians, managers, and policy makers with the evidence needed to assess the potential benefit of further wide-scale implementation of our practice-change package. International Registered Report Identifier (IRRID) DERR1-10.2196/22902
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Affiliation(s)
- Dianne Lesley Marsden
- Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia.,Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Brain and Mental Health Program, Hunter Medical Research Institute, Newcastle, Australia.,Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Newcastle and Melbourne, Australia
| | - Kerry Boyle
- Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia.,Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Brain and Mental Health Program, Hunter Medical Research Institute, Newcastle, Australia.,Belmont Hospital, Hunter New England Local Health District, Newcastle, Australia
| | - Louise-Anne Jordan
- Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia
| | - Judith Anne Dunne
- Rankin Park Centre, Hunter New England Local Health District, Newcastle, Australia
| | - Jodi Shipp
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, Australia
| | - Fiona Minett
- Manning Hospital and Wingham Hospital, Hunter New England Local Health District, Taree, Australia
| | - Amanda Styles
- Armidale Hospital, Hunter New England Local Health District, Armidale, Australia.,Tamworth Hospital, Hunter New England Local Health District, Tamworth, Australia
| | - Jaclyn Birnie
- Armidale Hospital, Hunter New England Local Health District, Armidale, Australia
| | | | - Kim Parrey
- Port Macquarie Hospital, Mid North Coast Local Health District, Port Macquarie, Australia
| | - Amanda Buzio
- Coffs Harbour Hospital, Mid North Coast Local Health District, Coffs Harbour, Australia
| | - Sandra Lever
- Ryde Hospital, Northern Sydney Local Health District, Sydney, Australia.,Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Michelle Paul
- Continence Service, Hunter New England Local Health District, Newcastle, Australia
| | - Kelvin Hill
- Stroke Foundation, Melbourne, Australia.,Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Michael R P Pollack
- Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia.,Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Newcastle and Melbourne, Australia.,John Hunter Hospital, Hunter New England Local Health District, Newcastle, Australia
| | - John Wiggers
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Health Research and Translation, Hunter New England Local Health District, Newcastle, Australia.,Public Health Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Christopher Oldmeadow
- Clinical Research Design & Statistics, Hunter Medical Research Institute, Newcastle, Australia
| | - Dominique Ann-Michele Cadilhac
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Newcastle and Melbourne, Australia.,Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.,Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Jed Duff
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
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