European Geriatric Medicine - Supplement 1 - Volume 6

Poster presentations / European Geriatric Medicine 6S1 (2015) S32

–

S156

S33

P-004

Urinary tract infection versus asymptomatic bacteriuria: an

audit on an important clinical dilemma

V. Carone

, M. Kenchaiah

, A. Bentley

Northampton General Hospital NHS Trust, Nottingham, United

Kingdom;

Northampton General Hospital NHS Trust, Northampton,

United Kingdom

Objectives:

Urinary tract infection (UTI) is common in the elderly,

and it is important to appropriately diagnose and treat it. However,

in view of the alarming increase in antibiotic resistance, it is crucial

to differentiate true UTI from asymptomatic bacteriuria (AB), which

is also common in the elderly but should not be treated. The

objective of this retrospective audit was to evaluate whether the

screening for UTI (using dipsticks) in a district general hospital

adhered to the international guidelines, in particular in elderly

patients.

Methods:

100 clinical notes of patients of both sexes, aged ≥18

years, admitted to the acute medical take in November and

December 2014, were randomly selected. Data were collected and

analysed to find common patterns of screening and diagnosis of UTI

versus AB. The majority of the sampled population was aged ≥65

(74%). Data were compared to the standards set by the European

Association of Urology.

Results:

Screening for UTI was inappropriately performed in 56.6%

of patients aged ≥65, and in 75% of them AB was misdiagnosed and

treated as UTI. No unifying criteria were found in the way screening

was performed and its results interpreted by clinicians.

Conclusions:

Screening for UTI was substandard and AB was too

often treated as UTI, leading to inappropriate use of antibiotics,

especially in the elderly. A clinical staff education programme is

proposed in order to raise awareness of the difference between

AB and UTI and reduce the risks of antibiotic resistance and

opportunistic infections such as

Clostridium difficile

P-005

The application of team resource management for effective

multidisciplinary team working in the emergency department

in a community hospital in Southern Taiwan

S.-L. Chou

, M.-Y. Chou

, C.-Y. Chang

, F.-Y. Chen

, B.-C. Yuan

M.-S. Chang

Division of Emergency Medicine, Fooyin University Hospital, Pintung,

Taiwan;

Center for Geriatrics and Gerontology, Kaohsiung Veterans

General Hospital, Kaohsiung, Taiwan;

Department of Nursing, Fooyin

University Hospital, Pintung, Taiwan;

Department of Medicine, Fooyin

University Hospital, Pintung, Taiwan;

Division of Otolaryngology,

Fooying University Hospital, Pintung, Taiwan;

Division of Surgery,

Fooyin University Hospital, Pintung, Taiwan

Objectives:

Patient safety in an important issue in the emergency

department (ED), especially facing the growing ageing population

with complex conditions. The purpose of this study was to evaluate

the effectiveness of the application of team resource management

(TRM) in ED.

Methods:

The implements of TRM were applied in the ED of Foo-

Yin University Hospital, a community hospital in southern Taiwan.

The workshop and standard lectures on organizational/leadership

skills, team solidarity, communication and teamwork were given

for all staffs since 2011. The instructor taught different strategies

and tools monthly to promote the effective multidisciplinary team

working environment. Safety Attitudes Questionnaire based on

2008 Medical Design III Hospital Patient Safety Attitude Scale from

Taiwan Joint commission on Hospital Accreditation were used for

all ED staffs before and after TRM training program.

Results:

There are 4 physicians and 16 nurses completing the TRM

training program. The results of six categories of Safety Attitudes

Questionnaire improved after the TRM training program, including

teamwork climate (33.3% to 66.7%), safety climate (31.8% to 77.8%),

job satisfaction (31.8% to 77.8%), stress recognition (63.6% to 72.2%),

perception of management (18.2% to 44.4%) and working condition

(25.0% to 55.6%). Moreover, the annual quitting rate of nurses

decreased from 33.3% to 12.5%, and the rate of positive feedback

from patients increased from 2.6% to 57.1%.

Conclusions:

The Application of TRM in ED could improve the

effectiveness of multidisciplinary team working and patient safety.

Facing the growing ageing population, further study is needed to

confirm the effectiveness of TRM in ED.

P-006

The effectiveness of comprehensive geriatric assessment-based

intervention reducing frequent emergency department visits

in a tertiary medical center in Southern Taiwan

M.-Y. Chou

, S.-L. Chou

, C.-K. Liang

, M.-C. Liao

, K.-C. Hsueh

Y.-T. Lin

, H.-C. Lam

Center for Geriatrics and Gerontology, Kaohsiung Veterans General

Hospital, Kaohsiung, Taiwan;

Division of Emergency Medicine,

Fooyin University Hospital, Pintung, Taiwan;

Kaohsiung Veterans

General Hospital, Kaohsiung City, Taiwan;

Department of Family

Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan;

Kkaohsiung Veterans General hospital, Kaohsiung, Taiwan

Objectives:

The purpose of this study was to evaluate the

effectiveness of comprehensive geriatric assessment (CGA)-based

intervention for emergency department (ED) frequent visitors.

Methods:

From January to November 2013, older people visiting the

ED of Kaohsiung Veterans General Hospital for three times within

30 days were recruited for study. Those with critical condition or

pass away in ED, cancer in terminal stage or NG tube dislocation

were excluded. The staffs in ED would evaluate those frequent ED

visits first and consult our geriatric team for performing CGA and

geriatric intervention. Number of ED visits, admission time and

death in 1, 6 and 12 months were recorded for comparison.

Results:

Overall, 137 frequent ED visitors (mean age 80.3

7.2

years, 73.7% males) were enrolled for study, and 26 (19.0%)

were treated with CGA-based intervention. There were no

significant difference between geriatric intervention and non-

geriatric intervention groups for age, gender, triage and tentative

diagnosis. Comparing with non-geriatric intervention group, those

with geriatric intervention would more likely to be admitted (50.0%

versus 21.6%, p = 0.003) in ED, to visit ED for less times within 1

month (0.81

0.85 versus 1.75

1.16, p

0.001) and within 6 months

(2.23

2.56 versus 3.97

3.17, p = 0.010).

Conclusions:

For frequent ED visitors, the CGAt-based Intervention

could reduce the times of ED visits within 1 and 6 months

significantly. Further randomized control trial with standard

inclusion/exclusion criteria is needed to confirm the effectiveness

of CGA-Based Intervention among frequent ED visitors.

P-007

Massive hematemesis due to fistula between an artery of the

intrathoracic goiter and the middle esophagus in an elderly

patient

Y.R. Davila Barboza

, E.H. Azana Fernandez

Hospital San Juan de Dios, Le´on, Spain

Introduction:

Relatively few case reports have been published on

bleeding due to fistula in relation to thyroid pathology.

Method:

Literature review and patient clinical documentation

Results:

An 81 year-old-man was admitted to the Geriatric

Deparment because of pneumonia. She had a history of

hypertension, recurrent goiter after a subtotal thyroidectomy in

1979 for multinodular goiter, chronic renal failure.

Treatment:

Levothyroxine, furosemide,omeprazole, amlodipine.

During hospitalization presents hematemesis, she received

transfusion of packed red cells and underwent a gastroscopy