Key messages

  • A key area of focus for the Victorian Stroke Clinical Network (VSCN) is to implement evidence-based care and reduce inappropriate variation in clinical practice.
  • Filling the Void improves the quality of continence care provided to stroke patients.

The VSCN Continence Initiative: Filling the Void (FTV) was created in response to consistent findings in the National Stroke Foundation (NSF) Clinical Audit that continence assessment and management in Victoria was poorly attended to. 

The findings reported only 36% of stroke patients were assessed for urinary incontinence within 72 hours of admission to acute stroke units, with only 23% of incontinent patients having a documented continence management plan This figure has not changed since the 2009 audit, and is consistent with national figures for this indicator. National data suggests that this issue is better managed in the subacute setting with 86% of patients receiving assessments for urinary incontinence as determined by the 2012 Rehabilitation Audit report.  

About the project

Filling the Void began in February 2015 as a six-month quality improvement cycle to improve continence care to stroke patients at Victorian public health services.

FThe aim of the initiative was to improve the quality of continence care provided to stroke patients receiving care from Victorian public health services. 

The objectives were to: 

  • engage clinicians from across the sector to improve clinical practice and patient experience and build capability in quality improvement and project management
  • support health services to examine their performance data compared to NSF findings and to undertake a six month quality improvement cycle. 

Filling the Void was the first time this type of collaborative model had been utilised by the VSCN, whereby participants attended three workshops and were supported through targeted capability building.

Ten public health services, representing metropolitan (70%), regional (30%), acute (one site), subacute (five sites) and community sectors (four sites) committed to the VSCN FTV initiative. Collectively the sites managed more than 2,000 stroke patients per annum and six organisations (60%) had existing protocols for urinary incontinence.

Outcomes

Outcomes Through the FTV initiative, health services learned and shared problems and spread solutions to support their peers to improve service delivery. Challenges included prioritising resources and managing competing priorities.

Overall the initiative was successful with health services awareness of the reasons for their gap in practice known, and most making moderate to significant changes to urinary continence clinical practice. All participating health services improved urinary continence care in either or both assessment and management.

The results of the initiative include:

  • a 54.6% average improvement in assessment of urinary continence achieved across five health services
  • a 39% improvement in urinary continence management achieved by one site, and 100% documented urinary continence management plans achieved by another
  • a capability increase in the project management and redesign methodology in all project leads (n = 10) and improved continence management practice within all health services.

Urinary continence measures guide

The urinary continence measures guide was developed as an output of the project to support other health services in undertaking improvement work on urinary continence, and to share some of the learnings from the project.

Dissemination

Findings from the project were presented at the 2016 Asia Pacific Stroke Conference and the 2016 Smart Strokes conference.

A recording of the webinar on this topic is available on the Inform Me website

More information

For further information on the project, please contact Sonia Denisenko, manager, Victorian Stroke Clinical Network via 9096 1297 or stroke.clinicalnetwork@dhhs.vic.gov.au

Contact details