bluuebunny/crossref_metadata_2025_split huggingface dataset:
210 Nursing Home Residents in Acute Hospital – a Targeted ANPc Program to Improve Care
Authors: Noonan Claire , Ryan Dan , Coughlan Tara , Kennelly Séan 
Published: September 2019

Abstract

Background
NHR are the frailest group of older people and require a gerontologically attuned approach to combat multiple challenges presented to the practitioner. The in-reach ANPc liaison service aims to confront such challenges, by providing comprehensive gerontological input to all nursing home residents admitted to hospital under all specialities medical, geriatric, and surgical.

Methods
This service commenced in September of 2018, working 9-5 Monday to Friday with limited leave cross-cover. All nursing home residents are reviewed by a Gerontology Advanced Nurse Practitioner candidate. Each patient received comprehensive geriatric assessment (CGA) with recommendations for care. All had follow up 2 weeks after discharge in telephone review clinic.

Results
118 nursing home residents were admitted for acute care in the study period; 96/118 (82%) were reviewed by the ANPc. 16/118 (14%) were discharged prior to review and 6/118 (5%) died within 24 hours of admission. All other patients were reviewed within 72 hours.
All assessed residents had >1 recommendation for intervention to enhance care following CGA:
Interventions included 31% (30/96) undiagnosed delirium identified and management advice given. 21% (20/96) had recurrent falls work up and advice. 27% (26/96) had recommendations and changes to admission medications. 37% (36/96) referrals to other HSCP therapy disciplines for complete holistic care. 11% (11/ 96) had advanced care planning regarding future illnesses. 13% (13/96) had palliative care advice and referral to community palliative care.
Follow up telephone review clinics have further resulted in reduced readmission rates through liaison with NH staff post-discharge.

Conclusion
The high complexity of this cohort of patients requires a timely, comprehensive gerontological approach in order to provide holistic care. They require a clearly defined approach to enhance care and minimise the need for unnecessary hospitalisations.
216 Integrated Day Hospital for Older Persons in a Primary Care Centre
Authors: McGrath Fiona , Ronayne Sarah , McHugh Karen , McDonnell Mary , Muataz Elnsari , O’Malley Tom 
Published: September 2019

Abstract

Background
To progress with integrated care, for older persons, it was proposed to establish a Day Hospital in a Primary Care Centre. Population data for Co Mayo shows the percentage of those over 65 years, (17.6%), to be significantly higher than the national average
In 2018 there were 39,092 attendances to the Emergency Department and approximately 500, per month, were over 75 years.
The aim was to develop a pathway from the Emergency Department to the Day Hospital for those 75 years and over who had experienced a fall. Additionally, this included an Early Supported Discharge for hip fracture patients.

Methods
The Day Hospital was operational 1 day per week with an allocation of funding for a Consultant, Occupational Therapist and assigned Project Manager.
Holter and Blood pressure monitoring equipment was purchased.
The Home First Team were reassigned to the front door of the hospital and worked with a cANP and a Medical Registrar.
A weekly multi-disciplinary forum, inclusive of all stakeholders, developed working relationships, built a shared vision and standardised the approach for the patient cohort.
Frailty training was provided specifically to Emergency Department staff.

Results
The Home First Team saw 541 patients (Jan-Apr 2019) and in collaboration with the Geriatrician streamed those suitable for management to primary care.
The Integrated Day Hospital, 1 day per week (Jan-Apr 2019) delivered 55 new assessments plus follow-up appointments.
Patient feedback is very positive and specifically highlights ease of access in primary care.

Conclusion
Establishing a Day Hospital in a Primary Care Centre is an innovative approach and shifts the focus of intervention from acute to primary care. The location is ideal due to a range of disciplines on site, PHN, Dietetics, Psychiatry
This is the initial phase, with some pathways in place, and the overall aim is to provide GP access to rapid assessment in Primary Care and thus ensure hospital avoidance where possible.
225 Assessment of Well-being after Stroke
Authors: Donaghy Lisa , McAteer Claire , Morrison Laura , O'Connor Marie , Dolan Eamon 
Published: September 2019

Abstract

Background
Studies have shown that people who have had a stroke are more likely to experience a lower sense of overall well-being, including cognitive impairment, mental health issues, and physical function, than similarly aged people1. Cognitive impairment and memory dysfunction following stroke diagnosis can significantly impact patients’ quality of life2. The aim of this study was to identify how stroke has affected patients at a university teaching hospital stroke clinic in terms of memory, mood and how they are managing at home.

Methods
Thirty anonymous patient questionnaires were completed at a stroke clinic in April 2019. 100% response rate was obtained. Questions included how patients found their mood and memory, and how they were managing at home following their stroke diagnosis.

Results
50% of respondents reported having memory difficulties post-stroke. 57% described low mood since their stroke. 43% required additional help following discharge home, with 69% of this extra help coming from family support. 13% felt they need more help at home than they currently have, with one of these four respondents awaiting a home care package. 20% of patients received further rehabilitation as an outpatient on discharge.

Conclusion
This study highlights significant concerns from patients following stroke with regard to their memory and mood. This emphasises the importance of formal assessment of mood and memory both during admission and on an ongoing basis post discharge. A significant proportion of patients required additional help at home with family members providing the majority of this support.
239 Setting Bones and Getting Home: The Impact of a New Orthogeriatric Service
Authors: Murphy Robert , Reddin Catriona , Dempsey Aoife , Kissane Bláithín , Waters Ruairi , Walsh Thomas , O'Keeffe Shaun , Mulkerrin Eamon , Robinson Stephanie , Egan Ciara , Byrne Fergus , O'Donnell Martin , Murphy Colin , Canavan Michelle 
Published: September 2019

Abstract

Background
Orthogeriatric services have been shown to improve quality of care for older patients post hip fracture and have an impact on length of stay (LOS), both acutely and in the rehab setting(1) but other key performance indicators (KPIs) have not been examined in detail.

Methods
Data was prospectively collected on all hip fracture patients seen by the Orthogeriatric service from Aug 2018-Feb 2019 and was retrospectively compared with patients admitted with hip fractures from Aug 2017-Feb 2018. We examined KPIs including LOS on the orthopaedic ward, rehab admissions, rehab LOS, new nursing home (NH) admissions. We compared the proportions discharged directly home instead of to convalescence, and conducted a preliminary cost benefit analysis.

Results
Similar numbers of patients were seen in each time period (n=146 v n=139). Mean reduction in LOS on the orthopedic ward was 3.5 days (15.5 days vs 19 days). The proportion of patients admitted to rehabilitation increased from 8.8% to 17.5% (p = 0.02). Patients got to rehabilitation faster and for those patients who availed of rehabilitation they had significantly shorter total length of stays (51.1 days vs 71.6 days, p=0.029). Fewer patients went to convalescence. Although not statistically significant there was a trend towards an increased proportion of patients discharged directly home (32.7% to 43.6%) and less new nursing home admissions (6.8% vs 8.4%). A cost benefit analysis incorporating shortened acute and rehab LOS and a reduction in spending on convalescence resulted in a projected saving of €480,390 over a six month period.

Conclusion
Introduction of OrthoGeriatric services has improved care for older people with hip fractures and has resulted in positive improvements to KPIs, resulting in meaningful improvements in clinical outcomes for patients in a cost effective manner. Monies saved should be redirected into further developing orthogeriatric services.
240 Assisted Decision Making (Capacity) Act 2015: Embracing the Paradigm Shift
Authors: Walsh Mary , Lawlor Aideen 
Published: September 2019

Abstract

Background
In a conference 2018, Senator Kelleher said she concurred with the statement describing ADMA “…. as a paradigm shift…a major, major culture shift which has yet to work through our societal systems….”(1) In 2016, a senior and manager speech and language therapist (SLT) won the Dementia Elevator Innovation Award with the project “Empowering Persons with Dementia to Become More Active Participants in Decision Making Related to Their Present and Future Needs”. The IASLT Position Statement on the role of the speech and language therapist (SLT) in assessing Capacity and Facilitating Understanding to Support Decision Making for Adults with Communication Disabilities 2017 names training others in assisted decision making as a key SLT role. Talking Mats (TM) (2) may help address some training issues outlined. TM is discussed in NICE-Capacity Guidelines 2018. The Phase 1 project outlined recommends progression to Phase 2.

Methods
In 2018, the senior SLT trained SLTs working professionally with people with dementia across different service settings. They made a prior commitment to attend and complete the course and to trial TM with people with dementia.

Results
The Phase 1 report Dec 18 contains 16 brief case studies. Some initial findings: Facilitates strengths rather than deficits.Helpful for assisted decision-making when listeners are trained.Pictures help maintain attention and aid comprehension.Pictorial record of photographed TM viewed very positively, particularly for meetings.Video recording sessions, with consent, greatly enhances reflective practice.It helped address the unmet needs of one person with dementia who presented with responsive behaviour.

Conclusion
Talking Mats was strongly endorsed by all participants. Recommendations in Phase 1 report 2018 included progressing to Phase 2 i.e. training the six SLTs to become TM trainers and commence cascading through the system. We are currently awaiting funding approval.
244 Point Prevalence of Frailty and Confusion Exceeds the Capacity of a Single Ward - Specialist Geriatric Wards to Lead Best Practice
Authors: O' Donnell Desmond , O'Mahony Anne , O' Donoghue Alice , McMahon Clare , Doyle Marie , O' Gorman Millie , Mulcahy Riona , Pope George , Cooke John 
Published: September 2019

Abstract

Background
Our Model 4 Hospital will open a Specialist Geriatric Ward in the coming months. This ward will focus on the provision of evidence-based care to confused and frail older adults. Careful selection of patients who would most benefit from this care will be vital to ensure success. We aim to determine the prevalence of frailty and confusion in our inpatient cohort to determine expected demand on this new service and to inform admission criteria.

Methods
All adult inpatients were screened for frailty (pre-admission status) using the Rockwood Clinical Frailty Scale (CFS). Point prevalence of confusion (combination of pre-existing dementia and incident delirium) was calculated by measuring 4AT scores on all adult inpatients (>16 years of age), with the exclusion of obstetric, paediatric, critical care and psychiatric wards. Eleven wards were visited by a team of six experienced geriatric practitioners during a one-week period in April 2019.

Results
In total, 257 patients were assessed. The median age was 74 years (16-99). The majority were male (54.9 %). 152 patients resided on a dedicated medical ward (59.1%). The point prevalence of pre-morbid frailty (CFS Score ≥ 5) was 39.9%. The point prevalence of confusion (4AT score ≥4) was 24.4%.

Conclusion
Our data show that frailty and delirium are highly prevalent in hospital inpatients. It is not feasible for this number of frail and confused patients to be cohorted in a single specialist area. It is therefore important that each hospital determine admission criteria to identify those at greatest need. Clearly, given the prevalence outlined here, there will be a large number of patients likely to benefit from but unable to access a Specialist Geriatric Ward. These wards therefore need to also serve as exemplars of best practice so that evidence-based care for this vulnerable cohort can be disseminated within an institution.
25 The Post Fall Review- An Opportunity to Intervene for Bone Health
Authors: Lynch Amy , Kachappilly Reshmi , Steen Georgina , Lannon Rosaleen 
Published: September 2019

Abstract

Background
Falls are a common occurrence in Irish hospitals and can result in much morbidity and mortality for our patients. According to NICE guidelines, a multi-factorial falls risk assessment should be carried out for those patients at risk of falling, including assessment of osteoporosis risk and medication review. In practice, the post falls assessment is a golden opportunity to assess Osteoporosis risk and adequate bone protection.

Methods
We compiled a list of patient falls registered on the Datix incident reporting system for our five wards over a three-month period from 13/10/18-15/1/19. We looked at the note post fall from the reviewing doctor and documented whether bone protection was addressed and also whether a known history of osteoporosis was documented. This was done on our electronic patient record system.

Results
A total of 106 falls were recorded during this time period. 87% of falls had a documented review post fall. 83 reviews were by the intern on call and team reviewed in 54 cases, often after the intern. 2 of the notes documented whether or not the patient had a known history of Osteoporosis. There was no mention about the presence or absence of bone protection in any of the notes. 14%(15) patients were on bone protection. 37%(40) were on vitamin D or calcium. 2 patients sustained a fracture in their fall.

Conclusion
This audit highlights that bone protection and osteoporosis risk are rarely being addressed post fall. To improve this we are going to give education on post falls assessment (including evaluating osteoporosis risk and assessing current bone protection or need for bone protection) to incoming intern groups and doctors on teams assessing falls. We will reaudit 3 months after this education to evaluate whether there has been an improvement.
248 An Evaluation of Patient Education Post-Stroke
Authors: Morrison Laura , McAteer Claire , Donaghy Lisa , O'Connor Marie , Dolan Eamon 
Published: September 2019

Abstract

Background
In 2018, 212 acute strokes were diagnosed in our university teaching hospital. Our stroke service is evolving to meet the needs of this growing population. The aim of this study was to evaluate the knowledge patients have about their stroke diagnosis and identify how to improve education given post-stroke.

Methods
Thirty consecutive patients attending stroke clinic completed a questionnaire, including questions regarding aetiology of their stroke, medications started, driving and education received as an inpatient.

Results
The thirty patients were a median of 16 months post-stroke. One had a haemorrhagic stroke, all others ischaemic stroke. Only 33% correctly described the type of stroke they had. 50% correctly identified all the risk factors they had been diagnosed with, including atrial fibrillation, hypertension, hypercholesterolaemia and carotid stenosis.
70% of patients reported receiving education in hospital post-stroke. Of these, 13% received written information. 30% of patients were shown their brain scan and the majority (89%) found it beneficial. 71% of those who did not see their scan would have liked to.
52% reported knowing which medications had been started post-stroke but only 23% of patients listed new medications correctly. 43% of patients felt they did not receive enough information about new medications and 27% reported either sometimes or frequently missing medications.
77% of patients drove before their stroke. 74% of these reported that they were advised not to drive post-stroke. Of these, 35% correctly identified how long they were advised not to drive for. Only 26% of those driving before their stroke had driving advice in their discharge letter.

Conclusion
These results illustrate areas in which we can improve education post-stroke, including ensuring patients receive individualised information about the aetiology of their stroke, risk factors and the importance of new medications. It also highlights the importance of ensuring advice regarding driving is clearly explained and documented.
256 The Experience of a Dementia Diagnosis: Joint Submission from The Irish Dementia Working Group and The Dementia Carers Campaign Network
Authors: Whelan Clodagh , Ryan Kathy , Rowsome Micheál 
Published: September 2019

Abstract

Background
Members of the IDWG and the DCCN have differing experiences of receiving a dementia diagnosis. There is a disparity regarding how the diagnosis is communicated, follow up support and the approach of the clinician making the diagnosis.
To improve practice members of both self advocacy groups supported by The Alzheimer Society of Ireland collaborated with a GP to create a video targeting health care professionals.
The video aims to give an insight into the experience of receiving a dementia diagnosis and support best practice in the moment of diagnosis.
It communicates the lived experience of dementia to health care professionals and aims to inspire person centred communication and an understanding of the supports available to those health care professionals

Methods
1. Members shared their personal stories and gathered qualitative data from their fellow self advocates to create a script for the video.
2. Members collaborated with a GP expert to ensure health care professionals were aware of the supports available to them in making a diagnosis.
3. The video is currently being disseminated through professional groups, media and at conferences such as this

Results
A member of the IDWG and the DCCN will present both the video and their experience of engaging with professionals on this matter.
They will offer quantitative data on presentations and qualitative data on their experience.

Conclusion
This is the first campaign which the groups have undertaken together and the first which targets Health Care Professionals.
As a member of the IDWG (living with dementia) says; `for us receiving a diagnosis is not the end of a journey it is the beginning and you can make a huge difference to how that journey begins.
The audience at the IGS Conference is a critical one for the self-advocates and they would very much welcome the opportunity to present.
260 Recording of Syncope Presentations in Model 4 Hospital - Large Variations in Data Collection Systems
Authors: Ryan Sheila , Atikah Asri Nur , Cunningham Nora , Dooley Trina , Quinn Colin , Peters Catherine , O'Connor Margaret , Lyons Declan 
Published: September 2019

Abstract

Background
Patients with unexplained falls, syncope and dizziness frequently present acutely. There are multiple IT systems in operation across the acute hospital network with varying functionality relating to activity capture. MAXIMS is an electronic healthcare record used to capture attendances in our ED. Within our department a digital patient management system Electronic Patient Management System (EPMS) records clinical information from admission through to discharge. The Hospital Inpatient Enquiry System (HIPE) is the principal national source of discharge information from acute hospitals. We aimed to look at this cohort of patients and compare the clinical data available on each of these information sources used in a Model 4 teaching hospital.

Methods
MAXIMS database was interrogated to examine patients who presented to the ED with the search terms “falls”, “syncope” and “dizziness”. We conducted a review of all patients who met our search terms over two non-consecutive weeks in 2018. For the same period EPMS was interrogated and HIPE data were requested and analysed.

Results
MAXIMS, EPMS and HIPE records over the two-week period captured 190, 104 and 24 patients respectively. Mean age was 62, 75 and 72 years. Of 190 records on MAXIMS, 107 (56%) were not coded on HIPE following discharge. Of these 107 patients, 93 (87%) did not require a hospital admission and 14 (13%) patients self-discharged.

Conclusion
Current available digital systems provide inconsistent information relating to patients presenting acutely with falls, dizziness and syncope. How these conditions are captured electronically can vary between systems due to which parameters are recorded. HIPE stats were lower than Maxims/EPMS which may reflect the fact that HIPE only captures discharge diagnosis as opposed to presenting symptoms. In order to get a clearer picture of these conditions, and for planning purposes, an approach amalgamating the data from all systems into one electronic source would be required.
262 Training and Use of the 4AT by a Multi-disciplinary Team to Screen for Delirium in the Frail Adult
Authors: Ryan Siobhan , Cooney Eamonn , Sayers Karen , O'Reilly Aine , Maher Jennifer , Sayers Karen , Baburaj Binish , Donnellan Christina , Pillay Isweri 
Published: September 2019

Abstract

Background
Detection of delirium risk may improve outcomes. We assessed the prevalence of patients at risk of delirium assessed by a trained interdisciplinary team.

Methods
An interdisciplinary team: dietitian, physiotherapist and speech and language therapist was trained to use the 4AT. Community dwelling patients, identified as frail during triage in a hospital emergency department, were assessed including a 4AT, over a 2 month period. Age, gender, Clinical Frailty Score (CFS), 4AT, Modified Barthel index (mBI), polypharmacy (as defined by 5 or more medications) and presence of hearing or visual impairment were entered onto Excel. Performance of the 4AT was at the discretion of the assessor.

Results
150 consecutive patients were assessed. The mean(SD) age was 83(5.1). Female to male ratio was 1.2:1. Mean(SD) CFS was 5.6(1.0).
29(19%) patients did not have a 4AT performed. 63(42%) patients had a 4AT of 1-3. 16(11%) patients had a 4AT of 4 or greater. 42(28%) had a 4AT of zero. Patients with a 4AT 4 or greater were older, mean(SD) age 86(4.2)years. Polypharmacy was present in 10(60%) patients with 4AT 4 or greater and 40(38%) with 4AT less than 4. 10(60%) of patients with 4AT 4 or greater had hearing and visual impairment. 16(15%) patients with a 4AT less than 4 had hearing and visual impairment. 10(60%) of patients with 4AT 4 or greater had a reduction in mBI. 33(31%) of patients with a 4AT less than 4 had a reduction in mBI.

Conclusion
Interdisciplinary teams can screen for delirium risk in ED. Frail patients at risk of delirium are older, have higher rates of polypharmacy, visual and hearing impairment and functional decline. It is possible to evaluate delirium in ED. Further work is needed to explore the relationship between the 4AT and frailty.