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S38
Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
For Unit A, the annual fall rate (AFR) was 3.3 in 2013 and 2.9 in
2014. The average age was 76 years. Of those who fell, 48% in 2013
and 42% in 2014 were identified as at-risk using the Hendrich II Fall
Risk Model. Over the two years there was a decrease in unassisted
falls from 3.36 per 1000 patient days to 1.06; the annual fall with
injury rate was 0.9 in both years.
For Unit B, the AFR was 2.4 in 2013 and 3.3 in 2014. The average
age was 85 years. Of those who fell, 66% in 2013 an 64% in 2014
were identified as at-risk. Over the two years there was an increase
in unassisted falls from 2.00 per 1000 patients days to 4.00; the
annual fall with injury rate was 0.8 in 2013 and 1.4 in 2014. The
majority of falls were unwitnessed, and involved patients using the
bathroom and those that fell trying to get out of bed. There is no
statistically significant reason to explain the differences observed
between the two inpatient units.
In our study the Hendrich II Fall Risk Model identified only 42
to 66% of patients that fell. We need to continue to develop and
incorporate further screening and prevention protocols.
P-024
Are admissions to hospital from an integrated health and
social care hospital avoidance scheme preventable
. . .
C. Lisk
1
, V. Poinoosawmy
2
1
Barnet hospital, Royal free NHS foundation Trust, London, United
Kingdom;
2
Potters bar Hospital, Potters bar, United Kingdom
Background:
HomeFirst; a multidisciplinary team integrating
health and social care was established in Hertsmere, United
Kingdom in January 2013, with the aim of reducing hospital
admissions by providing rapid response (RR) and virtual ward
(VW) services in patients’ homes. Whilst data exists for Hospital
readmissions, data on hospital admission from hospital at home
services is sparse. We looked at admissions from Homefirst to
hospital to define the characteristics of admission and determine
its appropriateness in order to identify trends we could learn from
as a team.
Methods:
A retrospective study looking at all admissions from
Homefirst to hospital over an 8 month period from May 2014
to January 2015 was done. Demographics and hospital diagnosis
and appropriateness was determined by 2 clinicians using a
spreadsheet.
Results:
92 patients were admitted to hospital over the 8
month period. The age range was 57–99. 62% (57) were
deemed unavoidable; being admissions for acute medical and
surgical emergencies or situations requiring patients to have
immediate further investigations. Infections requiring intravenous
antibiotics (18) was the commonest reason. 11% (10) were admitted
for inpatient rehabilitation, whilst 15% (14) were deemed to be
avoidable. The avoidable admissions were for infections requiring
oral antibiotics (8), medication adjustment (1), hypotension (1),
specialist opinion (1), syncope (2) and hemorrhoids (1).
Conclusions:
Some hospital admissions from an admission
avoidance service are unavoidable. It is important that community
teams regularly review reasons for admission to hospital so that
they can learn from this and prevent this from happening in the
future.
P-025
Hospital admission avoidance; data from 1392 patients referred
to the rapid response service
C. Lisk
1
, S. Mani
2
, D. Bertfield
2
, A. Ritchie
3
, A. Webber
2
1
Barnet Hospital, Royal free NHS foundation Trust, London, United
Kingdom;
2
Barnet Hospital, London, United Kingdom;
3
Potters bar
Community Hospital, London, United Kingdom
Objectives:
The uk population is ageing and increasingly models
of care which cater for older patients in the community are
needed. Qualitative studies suggest that older adults would prefer
to be treated in their own home and this may be associated
with better health outcomes. Home-first; a multidisciplinary team
integrating health and social care was established in hertsmere,
united kingdom with the aim of reducing hospital admissions by
providing a rapid response (rr) and virtual ward (vw) service in
patients homes. We examined the impact of the rr arm of the
service on the care of older adults in hertsmere.
Methods:
Retrospective data analysis were conducted for all
patients referred to rr between january 2013 and february 2015.
Patient demographics, referral source, diagnosis, readmission rates,
admission rates per 1000 population were analysed.
Results:
1392 rr referrals were received of which 90% were
appropriate. The mean age was 83.9 years with a female
predominance. 29–74 patients were seen monthly. Most referrals
were seen at home with 1 hour (90%) with falls, infections (chest,
urinary and skin), carer breakdown, frailty and delirium accounting
for the majority of referrals. The median length of stay is 13.7
days with 5–8 patients being admitted to hospital monthly from
the home-first service. Emergency admission rates are lower than
neighbouring boroughs.
Conclusion:
Integrated health and social care teams providing a
rapid response service in the community offers a way forward to
care for older patients with multi-morbidity in their own homes.
P-026
Impact of falls and adverse drug events on health resource
utilization among older adult Singaporeans
K. Mamun
1
, M.H. Ngyuen
1
, L.L. Chen
1
1
Singapore General Hospital, Singapore, Singapore
Objectives:
This study aimed to (i) evaluate health resource
utilization (HRU) associated with falls and adverse drug events
(ADE) and (ii) characterize their causes and consequences among
older adult Singaporeans.
Methods:
Six month retrospective study done on patients age
65 years and above who visited Singapore General Hospital.
Records of emergency visits and hospital admissions were obtained
using ICD-9 E-code series. Patient demographics, reasons for visit,
costs and length of hospital stay (LOS) were retrieved from
electronic databases. Summary statistics were used to report
patient characteristics, common causes and consequences of falls
and ADE, and HRU. Multiple linear regression was utilized to
evaluate factors associated with increased HRU.
Results:
A total of 1810 and 171 cases of falls and ADE occurred
respectively during the study period. Among 881 (43.7%) falls and
162 (94.7%) ADE that resulted in hospital admission, the mean (SD)
LOS was 9.4 (11.8) and 5.9 (7.2) days correspondingly. The HRU cost
of these incidences amounted to $3,105,812.00. Mean (SD) costs
for falls and ADE were $2,981.86 and $2,434.43 respectively. The
most prevalent cause of fall was ‘fall on same level from slipping,
tripping or tumbling’ (n = 976, 56.6%). Concussion (n = 221, 12.2%)
and intracranial injury (n = 165, 18.7%) were common consequences
of falls. ADE were mostly unspecified at the point of diagnosis
(n = 113, 66.1%), commonly implicated agent was anticoagulants
(n = 51, 29.8%).
Conclusion:
Falls and ADE resulted in substantial HRU
associated costs among older adult Singaporeans. Multidisciplinary
interventions are needed to reduce the incidence of falls and ADE
in this population.