Introduction: Delirium is a neuropsychiatric condition which is independently associated with poorer outcomes, and is prevalent in those aged over 75. Early recognition and standardised pathways are key to delivering good delirium care. Despite this, there are no formal screening and standardised pathways in RIE ED. Baseline data suggested around 4% are being screened for delirium. Aim: To increase screening for delirium from a baseline figure of 4% to 75% for patients aged over 75 years of age attending RIE ED, and also to ensure initial investigations were initiated in any patients who were
Introduction: Orthostatic hypotension (OH) is common in geriatric inpatients and associated with an increased risk of falls, fractures, reduced quality of life and death. Therefore, recognizing OH early is important in prevention of this associated morbidity and mortality. A lying and standing blood pressure (LSBP) measurement is required for the diagnosis of OH and guidelines advice LSBP measurement in patients 65 years and older. Aim: This Quality Improvement Project aimed to improve rates of LSBP measurement on all geriatric inpatients during their current admission. To carry this out we
Background The increased operative risk for older adults remains a growing concern in neurosurgery. One method of managing this is the addition of embedded geriatric liaison teams for proactive management of older and frail patients in surgical settings. This study aims to evaluate the attitudes of healthcare professionals towards the Medicine of the Elderly Liaison to Neurosurgery Team at the Royal Infirmary of Edinburgh and to investigate the impact that the team has made since its inception in February 2021. Methods 17 staff members were interviewed: medical and surgical doctors as well as
Introduction During hospital admissions, there are individuals with rapidly deteriorating conditions that may be entering a terminal phase and clinicians decide ‘fast tracking’. The purpose of this audit is for better understanding of fast track process, to estimate, improve the process and develop a checklist applicable to all Care of Elderly wards. As a prerequisite for establishing NHS funding, documents are submitted to Clinical Commission Groups (CCG) depends on patients’ Boroughs. After CCG approval, discharge planning is facilitated by OT and doctors (package of care, discharge summary
Project Title: Timely administration of Parkinson medication in Emergency Department Background: This project was started to ensure that patients admitted to the emergency department with a known diagnosis of Parkinson’s disease are receiving their anti-parkinsonian medications in a timely manner. This would help manage their symptoms, prevent complications, decrease their length of hospital stay and lessen the diagnostic burden on the department. Project methodology: Data source for identifying the audit population: Patient notes and discharge summaries Audit population: Patients with known
A National Confidential Enquiry of Patient Outcome and Death (NCEPOD) report ‘An Age Old Problem’ in 2010 highlighted the failure of the NHS in providing good quality clinical care for elderly patients undergoing surgery. This report generated important guidelines aimed at improving the perioperative care of elderly patients. NCEPOD standards state 95% of elderly patients receiving a geriatric review as part of their perioperative care. A closed loop audit with two completed cycles in 2018 and 2021 and an ongoing cycle in 2022 looks at the compliance of Barnsley Hospital NHS Foundation Trust
Objective: Frailty patients undergoing emergency laparotomy (EmLap) experienced increased perioperative morbidity and mortality. We aim to explore the association between frailty scoring in EmLap older adults (>65 years) and 1-year post-operative morbidity and social care changes. Methods: Retrospective analysis was performed on the Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) database (2018-2019). Older adults with completed preoperative scoring markers (National Emergency Laparotomy Audit (NELA) and Rockwood Frailty Score (RFS)) were included. ‘Frail’ was defined as RFS>3 and
Background Hospital at Home (H@H) services exist across the UK to provide acute multidisciplinary care in an individual's own home. Evidence suggests this approach is safe for many older patients, and services are expanding to address expected winter challenges. We explored the views of staff working in these services. Methods We conducted 23 semi-structured interviews with multidisciplinary staff working across three H@H services in South East Scotland during March 2022. Questions focussed on service strengths and challenges aiming to identify common themes. Results There was high job
Introduction The impact of taking medications with anticholinergic activity is called anticholinergic burden (ACB). A high ACB can cause physical and cognitive impairment, especially in the elderly, and is associated with increased falls, incidence of dementia and mortality. Therefore, we audited our admissions with delirium to see if we deprescribed to reduce medication number and ACB and if this impacted sedation use. Method A list of 146 admissions over two months were analysed; 46 had a delirium diagnosis. The number of medications and ACB scores were calculated at arrival to ED, admission
Introduction: Patient observations and corresponding National Early Warning Score (NEWS) are valuable components in the identification of patient deterioration. NEWS is particularly important in our older population, whereby presentation of acute illness can be atypical and non-specific. Oxygen saturation and subsequent supplemental oxygen requirement are fundamental components of the NEWS, predicting delirium development, critical care admission and inpatient mortality. Consequently, inaccurate recording has implications for patient safety. Aim: To improve the accuracy of supplemental oxygen
An estimated 500,000 people present to UK hospitals with fragility fractures each year with an annual cost of approximately 4.4 billion pounds. NICE CG146 and NICE QS149 recommend that the risk of fracture be assessed in women over 65 years old and men over 75 years old, and in younger people if certain risk factors are identified. One of these risk factors includes the use of high-dose steroids which is defined by QS149 as the equivalent of 5mg prednisolone per day or greater for 3 months or more. This project aimed to improve the frequency both of fragility fracture risk assessment and bone
Are teams appropriately scanning patients who they know/suspect have sustained a head injury following an inpatient fall? This study examined the appropriateness of neuroimaging requests over 6 months on a geriatric ward at the Freeman Hospital, Newcastle-upon-Tyne. The study also examined whether scans were performed and reports made available within the NICE-stipulated time frames, and also looked at the falls review documentation, and the rationales for neuroimaging (including the role of anticoagulation). DATIX records of all inpatient falls from March-August 2022 were acquired, and the
Whilst providing an Emergency Department based Older Person Assessment and Liaison service (OPALs), patients were identified to attend following a fall when they had previously been seen in ED following falls during the preceding 3 months. When notes were reviewed, few fall referrals had been documented. A prospective audit was conducted to identify the number of eligible patient referrals to falls team for patients who attend the emergency department. Electronic patient records were screened to identify patients' discharge diagnosis of ‘fall’ ‘elderly fall’ or ‘head injury’ (included if the