Investigating models of continence care and service provision in regional Australia: a retrospective clinical audit

Abstract

A clinical audit of consecutive case notes of women who received care for continence conditions between 2011 and 2013 was undertaken to determine the success of the implementation of the service model ‘Right care, right time, right place’ health care at Barwon Health Service, in regional Victoria. Three key elements were assessed across the surgical outpatient department and community continence clinic and included: clinic characteristics, length of appointments and type of staffing; adherence to best practice assessed using the 2006 NICE guideline for the management of urinary incontinence in women; and the clinical pathway, which reviewed the length and number of episodes of continence care at each service. The audit included 72 case notes from the surgical outpatient department and 91 from the community continence clinic. When results were combined, the component of ‘Right care’ was adhered to in 75% of a single case note in only 25% of cases (community clinic 22% and surgical outpatient department 3%). The implementation of ‘Right time and right place’ continence care was also poor, with a lengthy and indirect clinical pathway: length of primary episode of care was 11 and 8 months at the community clinic and surgical outpatient department respectively; and entire length of care on average was 15 to 17 months for both services. The audit found that the implementation of a ‘Right care, right time, right place’ framework for continence care at the health service was not fully achieved due to many contextual and intrinsic factors at each clinic site. Identification of service differences provides a unique opportunity to develop service improvements and an impetus to investigate other models of best practice care, such as advanced practice physiotherapist or nurse-led continence clinics that could meet the future health care needs of women with urinary incontinence.