Background Up to 17.5% of admissions for older adults with frailty may be Preventable Emergency Admissions (PEAs). PEAs are costly and expose patients to complications including deconditioning, delirium, malnutrition and nosocomial infections. Royal Derby Hospital (RDH) has 1159 beds and cares for a population of around one million. The Frailty Emergency Assessment Team (FEAT) operates within the Emergency Department (ED) and Medical Assessment Unit. FEAT is multi-disciplinary, comprising nurses, physiotherapists and occupational therapists. Aim To reduce the number of PEAs for older adults
Introduction: Frailty is under-recognised in hospital leading to unwarranted variation in care. National guidance recommends that all healthcare professionals can identify frailty and offer interventions to reduce risk factors for frailty. Previously, physiotherapists working in Older People’s Medicine (OPM) did not record frailty status in their clinical assessment. This quality improvement project seeks to translate and implement best practice, supporting physiotherapists to record the Clinical Frailty Scale (CFS) score within routine patient assessment, so interventions can be initiated to
Background West Lothian has 17 care homes with 881 residents. General Practitioners (GP) undertake annual review of all residents, including medication review, with variability between practitioners. Introduction Multidisciplinary team (MDT) working is the cornerstone of comprehensive geriatric assessment. MDT meetings are an excellent environment for shared learning and discussion. We applied this principle to a 2-year project delivering structured MDT medication reviews of care home residents. Methods Funding was secured for a consultant geriatrician (0.5PA for 2 years, £6500 per year) to
Background: Hospital Electronic Health Records (EHRs) increasingly capture health and functional deficits. We report outcomes for acute cardiac patients in relation to an automated frailty measure derived from these EHR data. Methods: We conducted a retrospective observational cohort study of consecutive cardiology admissions aged ≥70 years between April 2016 and August 2020, to three hospitals across Edinburgh, Scotland. The Continuous Dynamic Evaluation of Frailty (CODE-f) is an automated score between 0 (no markers present) and 1 (all present) representing 12 deficits generated from 31
Background: Foot pain in older adults may reduce physical activity, resulting in impaired mobility and an increased risk of falls. Orthotics, both with and without a metatarsal pad, may provide foot pain relief and improved stability. Objective: Compare the use of Aetrex orthotics with and without a metatarsal pad in decreasing pain and fear of falling in older adults. Methods: 206 participants over 60 years old were randomised into the intervention group, who received Aetrex L2305 Orthotics with a metatarsal pad, or the control group, who received Aetrex L2300 Orthotics with no metatarsal pad
Introduction: The General Surgery directorate at Cardiff and Vale University Health Board secured funding for the appointment of a Memory Link Worker (MLW) for a 12-month pilot in the emergency stream. The aim of the MLW is to improve patient experience for those living with dementia/ cognitive impairment, or those who experience delirium whilst in hospital. In addition, the MLW role should increase awareness and completion rates of “Read About Me” (RAM). Method: The pilot scheme started in February 2022. Eligible patients were identified by ward staff or the Perioperative care of Older People
Introduction: Living with frailty is a risk factor for increased short and long term mortality. We aim to describe the uptake of escalation of care and resuscitation status discussions in frail older patients admitted to general, colorectal, and upper gastrointestinal wards. Methods: Prospective observational study of all patients aged 65 years and over admitted under general surgery 11th February to 11th March 2022 and a second cohort of patients hospitalised between 1st and 31st of October 2022. We scored frailty using the clinical frailty scale (CFS) and identified escalation of care
Background: There is a growing number of older adults in India and accordingly a rising burden of non-communicable diseases (NCDs). Poor medication adherence among patients with NCDs is prevalent in India and is associated with adverse outcomes, increased mortality and consequently increased patient and healthcare system costs. Understanding the factors which influence adherence across India is vital to guide interventions towards improved adherence. This study examined the factors influencing medication adherence in older adults (50 years or older) with NCDs in India. Methods:. Data analysis
Introduction The Same Day Emergency Care Older Person’s Unit (SDEC OPU) provides urgent holistic care, complementing acute and community services to deliver comprehensive geriatric assessment. In October 2022, we introduced a new clinical coordinator role with the aim of improving patient flow. Prior to this role existing, one clinician per day was assigned to take referrals alongside reviewing their own patients, without having an overview of the processes and outcomes of the day. The new clinical coordinator role included taking referrals, vetting patients in A&E, assigning tasks to
The 2020-21 Chief Medical Officer report described Treatment Escalation Plans (TEPs) as ‘Realistic Medicine in action.’ Our aim is to increase TEP completion on the Medicine of the Elderly (MOE) wards at the Royal Infirmary of Edinburgh to >90% by July 2023. Since August 2022, we collected weekly data from a single MOE ward. In October, we upscaled to include four MOE and one stroke ward. The notes of five randomly selected patients were reviewed weekly to see whether they have a TEP, and if so, which parts were completed. To further understand behaviours around TEP completion, we collected
Introduction: East Lothian Community Hospital (ELCH) comprises of 95 medical beds for older patients undergoing rehabilitation following acute admission or discharge planning. Ideally, transfers from acute hospitals should have Treatment Escalation Plans (TEPs) in place, however only 67% of patients had a TEP documented electronically within three days of ELCH admission. Overnight and weekend cover is provided through nurse practitioners or Hospital at Night (off-site), therefore documented individualised plans by senior decision makers in the event of clinical deterioration is vital
Introduction: Risk prediction tools help guide prognostic conversations and benchmarking in hip fracture care. The Nottingham Hip Fracture Score (NHFS) shows only moderate predictive ability for 30-day mortality. We assessed whether routine markers of inflammation could improve the discriminant ability of the NHFS to predict 30-day mortality following hip fracture surgery. Methods: We studied consecutive patients admitted with hip fractures at a large-volume trauma unit between 2015 and 2020. Baseline NHFS and postoperative outcome data were extracted from a local registry and linked to
Title: Bone health assessment audit cycle at Queen Alexandra Hospital, Portsmouth (Audit ID 5474) Background: Conducted in the Department of General Internal Medicine. Our focus group was elderly patients, especially women aged 65 and above and men 75 years and above as per NICE guidelines since these patients should have their bone health assessment done ideally. Local problems: Osteoporosis is very common affecting approximately 3 million people. Over 5,00,000 fragility fracture occurs in the UK each year. Our audit aimed to find the percentage of patients who underwent bone health
Introduction The National Quality Board published the first Guidance on Learning from Deaths in March 2017, which stated the aim of mortality review processes across NHS Trusts and provided a framework in identifying, reporting, investigating and learning from deaths in care. Homerton Healthcare NHS Foundation Trust considered how best to implement the Guidance: record mortality reviews, increase engagement within the Trust and disseminate learning. Method Whilst paper-based mortality reviews had already been conducted by some specialties, there was no Trust-wide process to record data and
Introduction: One in three hospitalised patients die within 12 months of admission, rising to 45.6% in individuals aged 85 and older. Resuscitation is rarely successful in this patient group. Most older persons are happy to engage in discussions regarding resuscitation and patients' and relatives' involvement is recommended by the General Medical Council and Royal College of Physicians. We aimed to increase the number of resuscitation and escalation of care discussions across our Ageing and Complex Medicine department to 90% by November 2022. Method: Retrospective review of randomly selected
Introduction: In 2021, there were 38,839 adults >65 years living in Brighton and Hove, 13% of the local population, compared to 18% in England. However, 56% of emergency laparotomy procedures in the UK are in the > 65s. At the Royal Sussex County Hospital, a consultant geriatrician was appointed to lead a Frailty Liaison Service to respond to the needs of frail older patients undergoing general surgery (GS). No process was in place for the early identification of these patients, so intervention decisions were being made without GS Frailty Liaison input, potentially leading to unnecessary
Introduction Xerostomia, also known as dry mouth, is prevalent in older populations and associated with key determinants such as continual use of medication, radiation, and chronic diseases. Xerostomia significantly increases the risk of experiencing demineralisation, dental caries, tooth sensitivity, candidiasis, and other oral conditions that may negatively affect quality of life. An effective strategy to manage the risk of dental caries for patients with xerostomia is the prescription of high-fluoride products with proven efficacy. The aim of this study was to provide evidence on the burden
Introduction: Elderly patients are susceptible to opioid-induced constipation (OIC) and often remain constipated despite regular laxative prescription. Naloxegol is a gastrointestinal opioid antagonist licensed for OIC in patients failing laxative therapy. Naloxegol’s higher unit price than standard laxatives may disincentivise hospital pharmacies from stocking and supplying it. We present a quality improvement project and cost-analysis on the use of naloxegol in treating OIC in the real-world setting of a post-operative geriatric ward. Methods: Initial audit- Review of inpatient notes from
Background Acutely unwell hospitalised older people have better outcomes including mortality and functional status when CGA (Comprehensive Geriatric Assessment) is performed. A previous complaint, escalated to the Scottish Public Services Ombudsman, highlighted issues with CGA documentation and recording MDT discussion. This pilot project’s aim was to create a method for documenting CGA MDT plans and to embed this as routine practice for all inpatients on a Geriatrics ward. Method Following consultation with staff on this ward, a sticker was developed detailing status of medical and therapy
Background: Delirium is common and experienced by 20% of all admissions to hospital1. Studies have shown a link between delirium and development of dementia2 but there are not many services to follow such patients up post-discharge. A new service has been developed at New Cross Hospital run by Care of the Elderly Consultants with an interest in Cognition. Methods: A delirium follow up clinic was designed to assess these patients after 6 to 8 weeks from discharge following hospital admission or reviews in Frailty. We set up a referral criteria for prolonged or recurrent delirium follow up