Evaluation of a new model of care for bladder management in a statewide spinal cord service.

Study design: Registry-based cohort study.

Objectives: To evaluate the impact of the introduction of a new bladder management model of care at the Victorian Spinal Cord Service (VSCS) on the incidence of subsequent emergency department presentations and readmissions to hospital for urinary tract infection (UTI) in the first 2 years after injury.

Setting: VSCS, Austin Health, Melbourne, Australia.

Methods: A new model of care that prioritized intermittent self-catheterization was implemented at the VSCS on 1 August 2017. Data from the Victorian State Trauma Registry and Austin Health medical record were used to compare the rate of readmissions, emergency department (ED) presentations and hospitalisations for UTI in the first two years post-injury before and after practice was changed.

Results: A total of 333 cases were included; 149 cases pre-model of care change and 184 cases after. 143 males and 41 females with a mean (SD) age of 48.9 (19.7) were admitted to the VSCS following the change in model of care. The rate of any subsequent hospitalisation for UTI (ED presentation or admission) was lower following the introduction of the new bladder management model of care (Incidence rate ratio 0.30, 95% CI 0.12-0.73).

Conclusions: Our data demonstrates the real-world impact of a change in bladder management after new SCI. These data strengthen the consensus recommendation in current practice guidelines.