Introduction Using a patient centred, valued based health care approach to reshape the acute frailty unit with the University Hospital of Wales. Our multi-disciplinary team provide our patients with a compressive geriatric assessment. The goal is to ensure our patients are treated in a timely, thorough manner to avoid deconditioning and hospital induced harm. We want our unit to be guided by the needs of our patient population. Methods A redesign of the service structure within the acute frailty unit was undertaken as a result a patient survey taken in 2021. The aim was to focus on concerns
Introduction: The benefits of early frailty scoring for patients over 65 presenting to emergency settings are well established. A scoping exercise in the Emergency Department (ED) at the University Hospital of Wales (UHW) identified lack of familiarity with the Clinical Frailty Scale (CFS) and time pressures as barriers to achieving frailty screening at triage. In response, the Frailty Intervention Team (FIT) at UHW developed the Self-Assessment of Frailty in the Emergency Settings Tool (SAFE-T). Methods: A PDSA cycle was performed to assess SAFE-T validity and the feasibility of
Introduction The World Health organisation states that polypharmacy is a major global challenge. Older people in care homes are at risk of harm with 91% taking 5 or more medications. Pharmacists play an essential role in conducting medication reviews, identifying potential drug related problems, and implementing appropriate interventions to optimise treatment. Method As part of a pilot project for The Welsh Government Six Goals For Urgent and Emergency Care Pharmacists in Swansea Bay University Health Board’s Medicines Management team worked in collaboration with Consultant Geriatricians at
Objective: To evaluate the environmental impact from home visits the ESD team carry out and the implementation of electric vehicles to reduce the carbon footprint. Methods: Travel expense data of the ESD team across the last 2 weeks of April was collected and CO2 emissions from each team member was derived. A focus group was conducted to gather the team’s stance on electric vehicles for home visits. Results: A significant amount of CO2 is produced daily, with the total across the two weeks being close to that of a small-to-medium enterprise. Introducing an electric vehicle would help reduce
Background: Good nutrition and hydration are essential to patient’s health and wellbeing. Reduced nutrition leads to increased hospital admissions, re-admissions, longer length of recovery, poor wound healing and sarcopenia. Introduction: In hospital inpatients, especially when frail or vulnerable, the ward’s duty is to ensure that appropriate pathways exist to support their nutritional status and identify those who need additional support, additionally making sure patients have access to food and drink. Our ward wasn’t compliant with hospital standards. Additionally, patients experienced
Introduction The Cardiff and Vale Memory Team is comprised of a range of healthcare professionals who provide direct and indirect contact to coordinate the care of dementia patients. Memory link workers (MLWs) are a single point of contact for patients; they contact patient’s post-diagnosis and at 6-month intervals. Clinical Nurse Specialists (CNSs) assist patients with medical aspects of their care, including diagnostic home assessments with the support of the medical team. This evaluation aimed to establish the impact of these roles on people living with dementia and their carers. Methods
Introduction The weekend on-call team attends ward emergencies and front door new assessments. The extra routine ward work results in delays in the new assessments and adds further exhaustion for the on-call team, impacting junior doctor’s well-being and patient safety. Objective Aim to improve patient safety by facilitating the continuity of patient care over the weekend Method Group discussions among junior doctors, nurses, pharmacists, and ward managers were done to understand the challenges that impact communication. The average time spent on a ward by on-call team was 60 minutes. Plan-do
Introduction People with Parkinson’s (PWP) are twice as likely to fracture and over twice as likely to develop osteoporosis (1. Henderson et al, Parkinsonism & Related Disorders, 2019, Vol.64, pp.181-187). This is associated with significant morbidity (1). Assessment of bone health is often overlooked in clinic (2. UK Parkinson’s Excellence Network, 2019, pp.4-56), deeming it a priority area for improvement. Our project focuses on implementing routine bone health assessment for PWP in clinic, to achieve better standards of care. Methods This was a 12-week medical student led project
Postural Hypotension also known as orthostatic hypotension is defined as an abnormal drop in blood pressure on standing after periods of sitting or lying down, with a sustained reduction of systolic blood pressure of at least 20mmHg and/or diastolic blood pressure of at least 10mmHg. The prevalence of postural hypotension increases with age with one in five community-dwelling adults over the age of 60 years old and one in four people in long term residential care, which will ever grow with the growing elderly population. By discussing with patients on our ward it was clear that patients were
During the pandemic, diagnosing Dementia has declined significantly by over 35%. A Collateral history refers to information obtained from individuals other than the patient, such as family members, friends, or caregivers. This information is often crucial and can provide valuable insights into a patient's medical history, symptoms, behaviours, and social circumstances. Studies have proven a collateral history can enhance medical assessment, improve treatment planning, aids safety concerns and act as a diagnostic aid. By obtaining information from multiple sources, Doctors can compare the
In 2021, Cardiff and Vale University Health Board’s average length of stay (LOS) in Assessment Unit (AU) for over 75-year-olds was 24.2 days, due to long waits for inpatient beds. Once admitted, 23% of patients moved wards three or more times. Patient experience scores indicated poor satisfaction levels, with nearly 50% of patients feeling their needs had not been met. Staff consensus was that the environment was unsuitable for older patients. The implementation of an enhanced frailty service began in November 2022. This was managed by a geriatrician-led team, with support from junior doctors
Introduction: The use of pneumonia scores to stratify the prognosis is very useful in general terms, since it allows objectively evaluating the risks in these patients. The main objective was to determine the usefulness of pulse oximetry as a substitute for urea of the CURB 65 score in the evaluation of the severity of comunity acquired pneumonia (CAP) in patients. Methods: open-label, mixed-type study, first cross-sectional phase Test vs. Test, second phase follow-up at 8 and 30 days. Carried out between November 2017 and April 2018. Results: 5 patients, gender distribution was comparable
Introduction: Ischaemic stroke has a poor prognosis, and hemorrhagic transformation after intravenous thrombolysis may increase morbidity and mortality in these patients. Methods: By means of a retrospective analysis, related risk factors were recruited for the analyses, including: smoking, alcohol, hyperlipidemia, and diabetes, among others. The statistical analysis was performed by ANOVA for quantitative variables and the Chi-square test for qualitative variables. Results: The study was carried out on 52 patients with acute ischaemic stroke treated with recombinant tissue-type plasminogen
Introduction: It is still debated whether hypothyroidism is an independent risk factor for cardiovascular events. Our objective was to evaluate the association between hypothyroidism and the risks of cardiovascular events and mortality through 3 stratification systems. Methods: A retrospective study was carried out by reviewing medical records in the period of January 2015 - December 2017 in a South American hospital. Geriatric patients who had fasting total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, and plasma glucose were included. Quantitative variables are
Introduction We plan fast-track discharges when a person has limited life expectancy and is reaching end of life. When such patients are identified, we use a simple fast-track tool to minimise the delay and reduce the need for in-depth assessments and paperwork. Despite being used very widely, there is very little data in literature regarding the indications for fast-track discharges and life expectancy of patients following discharge. We conducted this observational study to answer these questions. Methods We collected data over a three month period from the fast-track applications focusing
Introduction Postural BP readings are important in assessing older people, but are infrequently measured (1) The National Audit of Inpatient Falls (NAIF) 2022 has shown measurement of lying standing blood pressure (LSBP) remains below 50% (2) NICE guidelines suggest checking LSBP in patients with: 1) Hypertension and postural hypotension symptoms 2) Hypertension and Type 2 diabetes 3) Hypertension and age ≥ 80 years (3) 4) Patients presenting with falls (4). We aimed to update local data for LSBP recording and investigate LSBP measurements in hypertensive patients. Method Data was collected
Introduction: Delirium is a common presentation in older people and associated with falls risk, longer inpatient stay, post-discharge institutionalisation, accelerated cognitive decline and higher mortality. While median duration of delirium is reported as 1 week but for one third patients, symptoms may persist 3 months or more, even a proportion of patients will never fully recover to their pre-delirium cognitive baseline. It is essential we are sharing the diagnosis with people and their relatives in order to provide information, facilitate discussions around the risks of hospital versus