bluuebunny/crossref_metadata_2025_split huggingface dataset:
336 GEMS: Geriatric Emergency Service - Home Team Outcomes
Authors: Mulholland Ann , Gibbons Ruth , Reddy Danielle , Hayes Brennan Megan , Cornally Lorna , Gallagher Grainne , O'Callaghan Maureen , Nolan Jane , Normoyle Cathriona , Ahern Emer 
Published: September 2019

Abstract

Background
Frailty is now a key concept in healthcare service planning and delivery and is driving vertical and horizontal integration. Early identification of Frailty and early intervention with Comprehensive Geriatric Assessment (CGA) is fundamental to our GEMS. Older people with Frailty admitted to hospital who receive a CGA early are more likely to return home. Benefits are seen early and are sustained (Ellis et al 2011).

Methods
The aim of GEMS is to improve care, outcomes and the patient experience for older people living with Frailty. All people aged 75 years and older who attend as an emergency are screened on triage using the Variable Indicative of Placement Tool (VIP). The GEMS Acute Floor Team respond early to those who screen positive by starting a CGA. The GEMS Home Team was planned and developed in December 2018 to case manage those identified at risk of adverse outcomes by the Acute Floor Team.

Results
79% (502) of patients who received a CGA were case managed by the Home Team since December 2018. 3% were newly discharged to Long Term Care, 73% to their pre-admission residence. 14% of patients were discharged with an increase in Home Support Services (HSS) and 2% with new HSS. 24% were referred to 3rd sector supports in the community e.g. ALONE, SAGE etc. 48% were identified as appropriate for earlier discharge if supports e.g. Discharge To Assess were available at home.

Conclusion
The GEMS Home Team have developed and delivered a pioneering integrated care approach to the management of the older person. The Team are positively influencing the culture of Home First in the hospital and driving horizontal and vertical integration.
340 The Impact of Medicine Reconciliation by a Clinical Pharmacist Compared to Standard care for Elective Orthopaedic Admissions
Authors: Connell Yvonne , Cheallaigh Sadhbh Ní , O'Connell Charles , Byrne Stephen 
Published: September 2019

Abstract

Background
Medicine reconciliation is defined as ‘The process of creating and maintaining the most accurate list possible of all medications a person is taking’. Medicine reconciliation (MR) is supported by various Irish governmental agencies such as the HSE, HIQA, PSI and the State Claims Agency. In addition, Irish GPs and community pharmacists are strongly in favour of expanding the role of hospital pharmacists in MR at all transitions in care. The aim of this study are to establish the appropriateness of the current MR service in elective surgical admissions in a Dublin based hospital.

Methods
This was a prospective interventional study that included 200 consecutive patients who met the inclusion criteria. The study was conducted between May and June 2018. All patients in the study received standard care in the control arm, followed by enhanced care in the interventional arm with errors noted and rectified after each process, this design allowed patients under standard care to act as a paired control group. Sub group analysis was performed on the following: (1) those >/= 65 years, (2) female patients, and (3) patients with a BMI > 30kg/m2. Ethical approval was obtained for this project.

Results
MR was found to detect a statistically significant number of errors compared to standard care (p=0.039). In the sub-group analysis, those >65 years (p=0.0237) or female (p=0.001), were at statistically higher risk of experiencing a MR error, verses obese patients (p=0.389). The Cornish classification tool was used to assess severity of the MR errors; while 37.5% of patients experienced at least one MR error, only between 1.5% - 3.5% of errors were classified as Class 3 errors.

Conclusion
A full medicine reconciliation service could be of benefit to targeted patients including those aged over 65 years or female, experiencing polypharmacy, or those with communication difficulties.
56 Streamlining Referral Processes at a Tertiary Acute Medical Ambulatory Centre
Authors: O'Donovan Claire , Wright Steve , Towler Simon , Furness Erin 
Published: September 2019

Abstract

Background
The Acute Medical Ambulatory Centre (AMAC) was established with the goals of facilitating early discharge and preventing avoidable medical admissions. 12 months post its introduction, the service was inefficient and operating under capacity. A project aimed to improve the AMAC referral processes and increase the centre’s overall efficiency was undertaken.

Methods
Western Australia Department of Health Clinical Service Redesign methodology (a blend of Lean and Six Sigma methodologies) was used to complete the project. This involved process mapping, root cause analysis and solutions sessions with stakeholders, as well as a semi-structured phone interview with patients.

Results
Transition from a paper-based to an electronic referral system. Creation of an ‘AMAC Quick Reference Guide’ for doctors. Production of an AMAC contact card to be given to patients on discharge if they have AMAC follow up. Letters detailing the patient review are forwarded on the day of the appointment facilitating timely feedback to GPs. An AMAC information flyer for GPs is now available on the hospital website.

Conclusion
Redesigning the referral process to the AMAC has improved workflow and efficiency with significant improvements in staff satisfaction. The institution is aiming to become paperless and this redesign project has led to the elimination of another paper form. The success of the project is testament to the engagement of the staff involved and demonstrates the need for doctors to not only engage their medical colleagues, but also nursing and clerical staff. The redesign project has helped refocus hospital priorities and should hopefully see further support for the centre; developing the ambulatory model of care as an integral part of the service provided. Other centres can learn valuable lessons from our experience and develop similar strategies to cope with the ever-increasing demands on the public healthcare system.
72 Adult Safeguarding, Abuse of Vulnerable Adults and Mandatory Reporting: A Rapid Realist Review of the Literature
Authors: Donnelly Sarah 
Published: September 2019

Abstract

Background
The continuing evolution of adult safeguarding legislation, policy and practice in relation to the abuse of vulnerable adults reflects a growing awareness of the nature and extent of such abuse in Ireland. The Adult Safeguarding Bill, 2017 represents a progressive step in safeguarding older people and vulnerable adults. The intention of the Bill is to put in place additional protections for adults, in particular, for those who may be unable to protect themselves, such as older people or those lacking capacity. Part 3 provides for mandatory reporting by specified/named persons/professionals. This paper sets out to critically analyse the concept of mandatory reporting within adult safeguarding using international comparators as case studies.

Methods
A rapid realist review of adult safeguarding reporting typologies and systems in five key jurisdictions: Australia, Canada, England, Northern Ireland and Scotland, were explored to answer the question: ‘what works, for whom and in what circumstances?’ [1]

Results
Jurisdictions differ as to who the mandated reporters are, the scope and powers of mandatory reporting, and the types of abuse subject to reporting. Of significance is that the debate on mandatory reporting has increasingly focused on institutional settings, rather than more broadly across services. Key concepts identified are those of protection, empowerment and proportionality. Adult safeguarding legislation must therefore ensure that interventionist and compulsory measures to protect do not excessively restrict the rights of the individual.

Conclusion
Mandatory reporting may offer professionals increased powers to prevent and reduce the abuse of adults and older people, but this could also change the dynamic of relationships within families, and between families and professionals. Ultimately, the success of any legal approach will rest with professional judgment in balancing autonomy with protection.
77 Behind the Scenes: the Burden Experienced by Informal Carers of People with Dementia
Authors: O'Brien Roisin , Breen Fiona , Gibney Caoimhe , Mackey Laura , Guisado-Fernández Estefanía , Caulfield Brian , Curran Fiona , Power Dermot , O’Shea Diarmuid , Doyle Rachael , Blake Catherine 
Published: September 2019

Abstract

Background
Informal care is undoubtedly a vital to dementia care in Ireland. To date, little research has been carried out exploring the burden experienced by informal carers of people with mild to moderate dementia. The main aim of this quantitative study is to explore the burden experienced by caregivers, relative to dementia severity. The secondary aim is to identify risk factors which may be contributing to this perceived burden.

Methods
Fifty-two people with dementia(PwD) and their informal caregivers were recruited by convenience sampling, and data was collected as part of the ‘CHESS’ research trial. Data was collected during baseline assessments between April 2017 and September 2018. Dementia disease severity was measured using the Mini-Mental State Examination(MMSE), the Neuro-Psychiatric Inventory Questionnaire(NPI-Q), and the Disability Assessment for Dementia(DAD) scale. These outcome measures were then compared to levels of caregiver burden, which was measured using the Zarit-Burden Interview(ZBI). These comparisons were completed using Spearman’s correlations. Socio-demographic characteristics of both the carer and PwD were then compared to caregiver burden, using Mann-Whitney and Kruskal-Wallis tests.

Results
The results of the study substantiate that behavioural disturbances(p=0.000) and increasing disability(p=0.022) of the PwD are associated with higher carer burden. The study also identified potential non-modifiable risk factors for increased carer burden. These include spousal relationship to the PwD(p=0.096), older caregiver age(p=0.208), female carer gender(p=0.083) and higher educational attainment of the caregiver(p=0.035). Some of these differ from factors influencing burden in other international populations.

Conclusion
This preliminary analysis is the first study of its kind to be carried out in Ireland. It sheds light on potential predictors and risk factors for carer burden and shows need for future research to be carried out in this area. Such research would help to clarify interventions which could minimise the prevalence of the burden experienced by informal caregivers.
80 Sleeping Beauty
Authors: Cunningham Nora , McManus John , O'Connor Margaret , Gabr Ahmed , Ryan Sheila 
Published: September 2019

Abstract

Background
The artery of Percheron is a rare anatomic variant of arterial supply to the paramedian thalamus and rostral midbrain, and occlusion of the artery of Percheron results in bilateral paramedian thalamic infarcts with or without midbrain involvement. Early diagnosis of artery of Percheron infarction can be challenging because it is infrequent and early computed tomography or magnetic resonance imaging may be negative. Thus, it can be confused with other neurological conditions such as tumours and infections.

Methods
This is a retrospective case study of a gentleman admitted to a teaching Hospital in Limerick and diagnosed with an artery of Percheron infarction. Medical records and the neuro-radiological database were reviewed, and the diagnosis was made based on typical symptoms and radiological findings of artery of Percheron infarction.

Results
We report the case of a gentleman who was found unconscious in his car on the roadside during the daytime. He had a decreased GCS and upon arrival in the Emergency Department he was intubated and transferred to ITU
The initial head computed tomography performed on admission was reported as unremarkable. Bilateral ischemia in the paramedian thalamic nuclei was documented on a follow-up computed tomography on day 24 after hospitalization.
He was extubated after 24 hours. He made a full recovery and was discharged home on day 5.

Conclusion
Artery of Percheron infarcts are rare. The radiological diagnosis can initially often be judged as normal and in combination with variability in the neurological symptoms it is a rather difficult condition to diagnose.
89 Geographical Variation of Emergency Hospital Admissions for Ambulatory Care Sensitive Conditions in Older Adults in the Republic of Ireland
Authors: Walsh Mary , Cronin Sinéad , Boland Fiona , Ebell Mark , Wallace Emma , Fahey Tom 
Published: September 2019

Abstract

Background
Hospitalisation for specific conditions considered to be `ambulatory-care sensitive' (ACS) could signify problems with primary or outpatient care access. The aims of this study are to quantify and explore potential causes for geographical variation across emergency hospital admissions for relevant ACS conditions in older adults in Ireland.

Methods
The number of emergency hospital admissions among adults aged 65+ with a diagnosis of an ACS condition between 2012-2016 were extracted from Ireland’s Hospital Inpatient Enquiry system according to condition, sex, age-group, residence area and year. Conditions included chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes complications, angina (excluding therapeutic procedures), pyelonephritis and urinary tract infections (UTI), dehydration and pneumonia. Age-sex standardised discharge rates (SDRs) were calculated for 21 areas. Systematic components of variance (SCV) quantified variation. Regression analyses were conducted between SDRs and year, unemployment rate, % urban population, General Practitioner (GP) supply, and % short emergency hospital stays.

Results
In total, 147,722 emergency hospital admissions (50 per 1,000 eligible population; 49% male) were included. COPD was the most common condition (31%), followed by pneumonia (22%), pyelonephritis/UTI (21%) and CHF (16%). CHF showed low geographic variation (SCV=2-3). COPD, diabetes, pyelonephritis/UTI and pneumonia showed high variation (SCV=4-12). Angina and dehydration showed very high variation (SCV=12-50). In multivariable analysis, higher unemployment was associated with higher SDRs for COPD. Lower GP supply was associated with higher SDRs for CHF, diabetes and pneumonia. Rurality was associated with SDRs for angina.

Conclusion
The rate of emergency admissions for ACS conditions studied is in line with research in the United States, although COPD and angina account for a higher proportion of admissions in our study. There is significant geographical variation in ACS admission rates among older adults in Ireland. Further research should explore local factors influencing emergency admission, particularly in socio-economically disadvantaged areas and those with lower GP supply.
94 A Pathway of Care for Patients with Parkinson’s Disease in Cavan Monaghan Physiotherapy Department
Authors: Sweeney Mary , Creegan Maura , Hall Michelle , McGroarty Donna , Graham Jane 
Published: September 2019

Abstract

Background
New European guidelines for the physiotherapy management of patients with Parkinson's disease were published in 2014. Following on from this publication it was decided to review the current physiotherapy service delivered to our patients with Parkinson's disease across both counties and develop a new pathway of care in line with the guidelines.

Methods
A working group of physiotherapists was selected representing acute, primary care and disability services. This group initially met to review current practice.
Once the service was evaluated, the group created a new assessment form for use across all physiotherapy services in both counties using validated outcome measurements as recommended in the guidelines.
A training program was put in place to improve staff's skill level in using the new assessment form and treatment methods for this client group. It was decided that a yearly assessment would now be carried out on each patient with Parkinson's disease.
Feedback was sought from therapists and any issues were addressed by the working group.
As part of the pathway a new Parkinson's exercise group was created which runs twice yearly in both counties.

Results
In 2018, 18 patients attended an exercise class in Cavan, 16 attended in Monaghan while yearly assessments were also completed.
Patient feedback from the classes has been very positive and outcome measurements have shown an improvement. Patients enjoy the class setting immensely and physiotherapy staff feel their patients are benefiting from receiving a more prolonged period of intervention.

Conclusion
This new pathway of care has been an effective and efficient way of treating patients with Parkinson’s disease.
It has led us to identify changes in disease progression in a more timely fashion.
Outcome measurement is audited yearly to monitor quality of classes and benefit to patients.
We will continue to highlight the pathway with new staff and monitor staff satisfaction with its use.
101 First Steps Towards Tailoring Frailty Specific Clinical Pharmacy Referrals
Authors: O'Reilly Aine , Athanasiyar Vince , Ryan Siobhan , Pender Ciara , Maher Jennifer , Sayers Karen , Cooney Eamonn , Baburaj Binish , Donnellan Christina , Pillay Isweri 
Published: September 2019

Abstract

Background
Interdisciplinary frailty assessment teams are in development throughout Ireland. Clinical pharmacy assessment (CPA) improves patient outcomes. Review is time consuming. Prioritising patients using frailty-specific toolkits should result in the greatest benefit for patients in a resource-limited setting.

Methods
Consecutive acute emergency patients identified as Variable Indicative of Placement positive at triage, underwent standardised interdisciplinary assessment tool. Age, gender, reason for referral and clinical frailty score were recorded in an Excel database. From 7/1/2019 to 31/1/2019, polypharmacy, defined as 5 or more medications triggered CPA. In phase 2, 11/3/2019 to 5/4/2019, a prioritisation toolkit was used. This toolkit identified 4 groups. 1. Regular use of high-risk medication or greater than 10 medications. 2. Patients with specific pharmaceutical concerns eg. desire to reduce their medication burden; 3. Acute/Chronic Kidney Injury; 4. Medication related admission potentially related to medications or admitted with non-mechanical falls.

Results
In phase 1, 57 patients were referred with polypharmacy from 7/1/2019 to 31/1/2019. 49%(n=27) received CPA. The mean age(+/_SD) was 82.8(+/-6.5). The female to male ratio was 1:1. The average CFS score(+/-SD) was 5.8(+/-1.2). In phase 2, 45 patients were prioritised with the toolkit from 11/3/2019 to 5/4/2019. 55%(n=25) received CPA. The mean age was 81.1(+/-8.3). The female to male ratio was higher (2.8:1). The average CFS score was 5.9(+/-0.9).

Conclusion
The prioritisation toolkit slightly reduced the number of referrals for CPA. The total number of CPAs remained constant. Women accounted for a greater percentage of patients in phase 2, consistent with previously published work. Further prioritisation is needed to ensure that patients with the highest risk of medication-related safety issues are identified and reviewed. Further prioritisation will be trialled and analysed using a plan, do, study, act approach. The ultimate aim will be to create and validate a prioritisation toolkit for the frail elderly presenting through an emergency department.
119 The Perceptions of Older Patients and their Family or Caregivers Towards Physical Activity and Exercise in Hospital: A Qualitative Study
Authors: Mealy Bláthnaid , O'Neill Aoife , Danaher Dervilla , French Helen 
Published: September 2019

Abstract

Background
Between 30-60% of older people experience functional decline after hospitalisation which can be accelerated by inactivity in hospital. Family or caregivers can positively affect activity levels of hospitalised older people. We aimed to explore the perceptions of hospitalised older people and their family or caregivers towards physical activity and exercise during an admission to a Specialist Geriatric Ward in an acute hospital

Methods
A qualitative approach was taken, using semi-structured interviews with eleven patient participants and semi-structured focus groups with four family or caregivers. Thematic analysis was utilised to identify key themes.

Results
Three similar themes emerged from both groups: 1) personal feelings towards exercise or inactivity, 2) the role family/caregivers could play in facilitating exercise and 3) the role of hospital staff, which all impacted on participants’ perceptions towards exercise in hospital.
Personal influences including self-efficacy and appreciation of the importance of exercise resulted in more positive views towards activity. There was an acute awareness among some family of the dangers of inactivity.
Uncertainty existed regarding the role family or caregivers have in increasing patient activity levels. Some patient participants believed family involvement may increase activity levels, while others thought it would compromise their independence.
Both groups identified a need for more patient-specific information regarding activity in hospital. Both groups favoured hospital staff encouraging rather than restricting activity and felt that more doctors encouraging exercise would be helpful. The need for more opportunities for meaningful activity in hospital was highlighted.

Conclusion
Physical activity and exercise were perceived as important during hospital admission. Hospital staff should facilitate and enable increased opportunities for patient activity, and empower family or caregiver involvement in this where appropriate.
135 The Impact of an Early Mobilisation Initiative Evidence from an Acute Care Setting
Authors: Horgan Aileen , Carr Michelle , Murphy Aileen 
Published: September 2019

Abstract

Background
Unnecessary bed rest results in a loss of mobility and an increased length of hospital stay. Despite mobilising regularly being acknowledged as an important preventative measure for deconditioning, inpatient functional decline continues to pose a significant challenge in hospital settings. Hospital-based mobility initiatives offer the potential to address issues of functional decline, improve patient outcomes and hospital length of stay. The aim of this research is to examine the impact of an early mobilisation initiative called “End PJ Paralysis”.

Methods
The research design comprises of three elements: (i) an examination of a period that promoted mobility to all patients on one acute unit (ii) an analysis of the reported number of falls during the study period and (iii) an exploration of perceptions and attitudes of nurses, nurse managers, and patients involved with the initiative.

Results
Our study demonstrates that following a 10-week promotion of the initiative from April 17th-June 26th 2018 in an acute care setting in south of Ireland, an increase of 15% of patients were mobilising and a decrease in the number of reported falls. In addition, staff participation was found to increase and self-reported patient satisfaction improved. Factors identified as influencing the impact of the initiative included patient and staff behavior, nurse management leadership, and effective communication.

Conclusion
The study provides evidence to suggest that early mobilisation initiatives can prevent deconditioning and improve patient outcomes. Each day a patient spends in hospital should contribute towards their recovery and discharge and mobilising patients while in hospital has a profound impact on their functional status.