Authors (including presenting author) :
Siu YS(1), Wong TT(1), Tsang SM(1), Pang HSI(1), Lam CY(1), Wong CW(1), Wan MC(1)
Affiliation :
(1)Department of Medicine and Geriatrics, Ruttonjee & Tang Shiu Kin Hospitals
Keyword 2: :
nurse-led consultation
Introduction :
Urinary incontinence (UI) affects a high proportion of older adults worldwide. During hospitalization, UI was frequently undertreated and referred out to specialist clinics. In fact, Continence Nurse (CN) specialists play a crucial role in early identification, assessment and conservative management of UI which enhances service access, effectiveness, and reduce referral burden (1,2,3). In RTSKH, Continence team provided specialist consultation primarily in out-patient (OP) setting. In-patients (IP) identified with continence needs usually waited an average of more than 8 weeks upon discharge before receiving such service. This gap deferred continence assessment and management until after discharge and delayed initiation of conservative therapies.
Objectives :
(1) To enhance Continence service access, delivery and timeliness to all in-patients in RTSKH through a nurse-led Continence care model. (2) To improve patient outcomes and facilitate early discharge by shortening waiting time to specialist assessment and care. (3) To alleviate out-patient clinic referral demand.
Methodology :
An IP referral mechanism and workflow were endorsed. Three trained CNs ranked APN or above were deployed to provide bedside consultations across the hospital. (1) Within 3 days of referral, CN assessed patients with comprehensive history taking and focused continence assessments, reviewed patient progress, medication profile and laboratory results.
(2) CN then advised on individualized care plans focusing on trial wean off catheter (TWOC) or conservative strategies such as pelvic floor exercise, bladder training, lifestyle modification, diet and fluid adjustments, medication regime and follow-up or tertiary referral suggestions.
(3) If necessary, CN sought advice on management plan from the Geriatrician advisor for Continence Team.
Result & Outcome :
As of December 2025, 52 referrals (36 failed TWOC, 16 UI) were received. All patients were assessed by CN and received personalized interventions with care plans. Time to bedside consultations averaged at 3 days, a 95% drop of waiting time to OP appointment. Following CN assessment, 31 cases (60%) required no further referral to the OP continence clinic. Of the 36 referrals for failed TWOC, 12 patients (33%) finally achieved successful TWOC during index admission. All 16 patients referred for UI reported reduced UI severity and felt more competent to self-care upon discharge. Quality and safety were maintained with no related adverse event reported. To conclude, this nurse-led model is a feasible, high impact intervention that expands immediate continence-care capacity, accelerates access to care, facilitates early discharge, absorbs referral demands, improves patient and organizational outcomes, and aligns with international recommendations for early nurse-led management.
