Fixing a Wee Problem - Will the SCAMP (structured Urinary Continence Assessment and Management Plan) Intervention Make a Difference? - Study Protocol

Background Urinary incontinence has negative effects for patients and health systems. In recent Stroke Foundation audits, nationally 35% of acute and 41% of rehabilitation inpatients had urinary incontinence, but only half had associated management plans. Aim To determine if broader implementation (multiple Health Districts, across phases of care) of our previously-piloted multidisciplinary Structured urinary Continence Assessment and Management Plan (SCAMP) interventions (including clinically-applicable tools, processes and education; audit and feedback) improves inpatient post-stroke urinary incontinence assessment, diagnosis and management. Methods Design: before- and after-implementation study at six acute stroke/ medical units, two comprehensive stroke and six rehabilitation services in three New South Wales Local Health Districts. Primary outcome: change in the proportion of incontinent patients who have a continence management plan. Secondary outcomes: change in the proportion of patients who have a urinary continence assessment, documented incontinence diagnosis and receive continence education. We will also determine the intervention effect on clinician knowledge, skills and confidence, and potential cost-effectiveness (hospital perspective). Data collection: medical record audits, clinician questionnaires and site-specific teams identifying local barriers and enablers to continence management. Data will be collected for 3 months before and after the 7-month implementation period. Sustainability will be evaluated 16 months after implementation commences. Results Ethics is approved. Before-implementation data collection commenced January 2019. The project will be completed by July 2020. Discussion Our SCAMP interventions can potentially operationalise high-level concepts outlined in Australian stroke guidelines into effective clinical care across hospitals and phases of care. If successful, SCAMP can be readily-adopted nationally.