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Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
S43
P-042
Providing clear structure and leadership to an assessment
area can reduce patient length of stay (LoS) and enhance staff
experience
A. Watson
1
, A. Ali
2
, D. Aw
1
1
Nottingham University Hospitals, Nottingham, England;
2
United
Kingdom
Background:
In September 2014, the Geriatric department took
over the management of a medical assessment ward at Nottingham
University Hospitals. A large team of consultants provided daily
senior cover. Staff morale was low, patient care disjointed and
there was a lack of leadership and consistency in ward processes.
Objective:
To provide leadership and improve consistency of ward
processes to reduce LoS and enhance staff experience.
Methods:
A clinician lead and dedicated project manager were
appointed to provide leadership and engage the team in the
process redesign. Consultant job plans were modified to ensure
daily geriatric presence. A standardised operating procedure (SOP)
including roles and responsibilities was developed with the team.
Through a series of Plan Do Study Act (PDSA) cycles we
introduced:
•
A 9am “huddle” for staff allocation and safety and process
messages.
•
Morning and afternoon board rounds.
•
“One stop” ward rounds.
•
Prioritisation sheets (identifying patients medically unwell or
ready for discharge).
•
Optimised IT resources.
We ran focus weeks where aspects of the SOP were score boarded
to embed the process and enhance accountability.
Results:
LoS reduced from 35 to 29 hours. Morning and afternoon
board round consistency increased (from 18% to 80% and from 24%
to 60% respectively). Prioritised ward rounds increased from 18% to
100%. Consultants reported being clearer about their role (37% to
76%). The ward team felt happier coming to work (29% to 65%) and
felt valued (18% to 59%).
Conclusions:
Clear leadership structure and guidance on roles,
responsibilities and processes reduced length of stay, improved
flow and improved staff experience.
P-043
Older fall patients in the acute medical department:
A descriptive cohort study
M.R. Wejse
1
, A.-K. Giger
2
, E. Pressel
3
1
Dep. of Geriatric Medicine, Bispebjerg Hospital, University of
Copenhagen, Denmark, Copenhagen NV, Denmark;
2
Denmark;
3
Bispebjerg Hospital, Copenhagen NV, Denmark
Objective:
Fall upon admission in older patients is frequent and
often due to underlying disease, but little is known about this
patient group. The aim of this study was to describe the clinical
characteristics, complexity and illness-severity of a cohort of older
fall patients admitted to the acute medical ward.
Methods:
We included 21 patients (
>
65 years old) who were
admitted to the acute medical ward in October 2013 with the ICD-10
diagnosis fall (R29.6/7) or as a direct consequence of falling.
The cohort was studied retrospectively and data was collected from
the hospitals electronic journal system. We registered the number
of acute diseases diagnosed or treated within the first three days
after admission, vital parameters (EWS), 30-days mortality rate and
length of stay. Furthermore we registered 30-day re-admission rate,
comorbidity and polypharmacy.
Results:
33.3% of our patients had died 30 days after admission.
43.3% had been admitted to hospital 30 days before or after the
study period.
On average 3.9 acute diseases were diagnosed or treated during the
first 3 days after admission. The mean EWS-score was 4.2 indicating
a medium observation level. Our patients received on average 7.4
medications and had 6.0 comorbidities.
Conclusions:
Older fall patients in the acute medical ward are
characterized by acute medical conditions, multi-morbidity and
polypharmacy. Mortality and admission rates are surprisingly high,
indicating that there should be focus on these patients in the acute
clinical setting.
Further studies need to be done in order to proof our results in
larger cohorts.
P-044
Rates and potential risk factors for hospital readmissions of
older patients
M. Wibert
1
, B. Hamoir
2
, M. De Saint Hubert
3
, C. Swine
2
,
D. Schoevaerdts
4
1
CHU Dinant-Godinne, Courcelles, Belgium;
2
CHU Dinant Godinne
UCL Namur, Yvoir, Belgium;
3
CHU Dinant-Godinne, Yvoir, Belgium;
4
CHU Dinant-Godinne UCL Namur, Floreffe, Belgium
Objectives:
To determine potential risk factors and hospital
readmission rates within 6 months following an index
hospitalization and test the association with the LACE (LI) and
SCHONBERG indexes (SI).
Methods:
Retrospective observational study in a tertiary care
hospital, extracting clinical data from a computerized database.
Were included 369 patients more than 75 years hospitalized from
the emergency department (ED) during the first semester of 2014,
and assessed by the geriatric liaison team.
Results:
The readmission rates was 34% (95% CI: 29–40) at 6 months
from the index stay. Characteristics not significantly associated with
readmissions where: ISAR score, polypharmacy, a previous fall in
the past 6 months, living place, dementia and a low body mass
index. Six months readmissions were however associated with:
a previous ED visit (OR: 35.0; P
<
0.001), male gender (OR: 2.7;
P: 0.001), marital status (OR: 2.1; P: 0.003), assistance for ADL
(OR: 1.6; P: 0.039) and iADL (OR:1.6; P: 0.042), a high Charlson
Comorbidity Index (OR: 1.2; P
<
0.001), younger age (OR: 1.1; P:
0.018), a high level of LI (OR: 1.1; P: 0.004) and a high level of SI
(OR: 1.1; P
<
0.001).
Conclusion:
In our cohort one third of the older patients where
readmitted within the 6 months after discharge. A previous ED
visit strongly predicted readmission, as other factors or scores as
the LACE and SCHONBERG indexes.
P-045
Evolution of patients of 80 years and over after a stay in
intensive care unit: a retrospective study
A.-A. Zulfiqar
1
, V. Champenois
1
, M. Dram´e
1
, L. Kanagaratnam
2
,
B. Marinthe
3
, J.-L. Pennaforte
1
, J.-L. Novella
2
, A. L ´eon
1
1
CHU Reims, Reims, France;
2
France;
3
St-Dizier Hospital, Saint-Dizier,
France
Objectives:
Aging has led to an increase in the number of elderly
patients admitted to intensive care.
Methods:
Retrospective study in Intensive Care Unit at Saint-Dizier
Hospital including patients older than 80 years, during 1 year.
Results:
69 patients were admitted, 34 were women. The mean
age was 84.1 years (80–94). The majority of patients were from the
Emergency (42 patients). 13 patients lived at home without help,
while 35 patients lived at home with assistance and 19 were living
in institutions. Charlson score means in our series was 7.1 (4–9).
Cardiovascular history was the most represented (97.1%). Dementia
“known” for 10 patients (14.5%). Principal reason for admission in
Intensive Care remains acute respiratory failure (36 patients). The
mean SAPS II score is valued at 46.8
±
24.2 (18–113). The average
length of stay was 9
±
9.9 days (1–58 days). Therapeutic limitation
decision was made to 35 patients. 27 patients died in the intensive
care unit, which makes 39.13% of intra-ICU mortality. A total of