Improving in-hospital post-stroke urinary continence assessment and management by implementing the "Structured Urinary Continence Assessment and Management Plan (SCAMP)"- the study protocol

Background and Aims :Urinary incontinence is a common, costly but often overlooked stroke complication. We aim to determine if implementing our SCAMP intervention (includes previously-piloted clinically-applicable tools and processes and education, audit and feedback) improves urinary incontinence assessment and management for in-hospital patients following stroke. Methods :Design: pragmatic, before- and after-implementation study at six acute stroke/ medical units, two comprehensive stroke and six rehabilitation services in NSW, Australia. 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, recorded diagnosis of incontinence type/s, and receive continence education. We will also determine the intervention effect on clinician knowledge, skills and confidence, and the potential cost-effectiveness from a 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. To assess sustainability, outcomes will again be measured 16 months after implementation commences. Fifteen consecutive medical record audits (incontinent patients) per site per month will provide >80% power to detect a 20% absolute increase (from before intervention) in the proportion of incontinent patients with an incontinence plan (type 1 error rate of 5%). Results :Ethics has been approved. Before-implementation data collection is underway. The project will be completed by July 2020. Conclusions :We will translate high-level concepts outlined in clinical guidelines into effective and efficient continence care. SCAMP has the potential to be readily-scaled internationally.