bluuebunny/crossref_metadata_2025_split huggingface dataset:
2223 Older patients admitted with a fragility fracture—a review of discharge summary documentation in accordance with HIQA national
Authors: Redmond C , Thankachan N , Fallon A , McDonough A 
Published: August 2024

Abstract

Background
Fragility fractures, defined as fractures resulting from low energy trauma (1), are consistent with a diagnosis of osteoporosis. When a patient is discharged from hospital, guidelines recommend principal and additional diagnoses, relevant co-morbidities contributing to primary diagnosis, medications and relevant investigations are recorded (2).

Methods
This audit reviewed discharge summaries of all patients discharged from a rehabilitation unit over two months, in accordance with the Health Information and Quality Authority’s (HIQA) National Standard for Patient Discharge Summary Information (2). Patients with fragility fractures were identified through medical record review. Principal and additional diagnoses were reviewed, with cause and mechanism of falls considered relevant co-morbidities. Discharge prescriptions for anti-resorptive medications were noted. Dual-energy x-ray absorptiometry (DXA) was recorded as a relevant investigation (3).

Results
33 discharge summaries met inclusion criteria. 12 patients were admitted with fragility fractures with a mean age of 81 years (69–90). 83.3% (n = 10) were female. Osteoporosis was mentioned in 50% (n = 6) of discharge summaries of patients with fragility fractures. On review of relevant co-morbidities, likely cause of the fall was documented in 58.3% (n = 7) and mechanism in 75.0% (n = 9). Bone protection was planned in 83.3% (n = 10). Plan for DXA was documented in 8.3% (n = 1).

Conclusion
This audit demonstrates suboptimal communication between hospital and community teams, despite chronic disease being predominantly managed in the community. In Europe, Ireland has one of the largest disease burdens relating to osteoporosis and the largest increase predicted in the next ten years (4). It is of utmost importance we improve communication to minimise disease burden.
2276 IN REACH. It’s everyone’s responsibility. Improving inpatient access to food and drink.
Authors: Pottinger A , Tanner S , Saunders S , Gagliani R , Shaah E 
Published: August 2024

Abstract

Background
‘IN REACH’ was established, having identified a significant need to improve nutrition for cognitively and physically frail hospital inpatients, admitted to the Complex Medical Units (CMU) at the John Radcliffe Hospital. The IN REACH team includes the CMU multi-disciplinary team (MDT), representatives from patient and volunteer groups, caterers and medical illustrators.

Introduction
IN REACH identified that food and drink is often unreachable by inpatients. The project’s aim is to ensure food and drink is always within patient reach, improving nutritional intake, avoiding dehydration, reducing weight loss, reducing family anxiety, promoting independence and improving health outcomes.

Method
MDT members, patients and their families were engaged in the design. Baseline observational data included whether both food and drink were in reach and whether the patient had cognitive impairment. Interventions to be evaluated by Plan-Do-Study-Act (PDSA) methodology include: Focussed education, presenting observational data to MDT and catering team; raising awareness at daily MDT meetings, emphasising shared responsibility. Prompting by signage, physical and digital. IN REACH Champions to be introduced. PDSA cycles 1 and 2 were completed. 3. and 4. are planned. Improved inpatient nutrition will be correlated with data on length of stay and health outcomes, monitored by repeat PDSA cycles. Improved rates of return to baseline function and independence are anticipated, by keeping food and drink, in reach.

Results
Out of 319 inpatients, 33% had both food and drink within reach. 67% had cognitive impairment; 73% of those were unable to reach their food and drink. Following PDSA cycles 1–2, 34% of patients had food and drink within reach, a negligible change.

Conclusions
Most CMU patients have food and drink left out of reach. Patients with cognitive impairment are particularly at risk. Changing ward culture is challenging. Further and repeated interventions are necessary.
2278 Adding value to the patient experience through a clinically optimised pathway approach
Authors: Poddar S , Gunarathna D , Bowen B , Puffet A , Phillips T , Rogers L , Griiffiths Z 
Published: August 2024

Abstract

Introduction
High numbers of clinically optimised patients in a DGH were having daily clinical input. RAAC clinical incident resulted in movement of clinically optimised patients from the district general hospital to a community hospital increasing the community bedbase from 32 to 72. This gave the opportunity to review how these patients were managed.

Method
In the first PDSA cycle, it was recognised that daily medical ward rounds for clinically optimised patients were neither necessary nor optimal and potentially perpetuated the impression that patients required in hospital care. These observations were sought using process mapping and fish bone diagram. In the second cycle, all clinically optimised were planned to be seen once a week on ward round. All patients were discussed on the daily multidisciplinary board round and if needed were changed on the board to not clinically optimised which prompted review. Nurses could also ask for review outside of the board round.

Results
During a four-week period one third, (24/72) of patients needed review outside of the weekly planned review. Of these 79.2% required only one review. Consequentially junior doctors reported to save an estimated cumulative of 16–48 hrs per week. Balancing measures of falls, mortality, pressure sores and complaints showed no change in the four months after implementation of the change. Patient, family and staff qualitative feedback was gathered. The next two cycles involved polypharmacy review and offered clinically optimised patients a ‘What Matters to Me’; meeting with their family utilising the time saved to improve communication, medication review and future care planning.

Conclusion
Data suggested no adverse impact of change in practice. Staff were redeployed to the front door frailty team rather than community hospital to improve access to Comprehensive Geriatric Assessment, and a new pathway was designed to create uniformity in flow for admissions to frailty.
2326 Improving recording and documentation of lying standing blood pressure In patients &gt; 65 admitted with/At high risk of fall(s)
Authors: Shipperbottom L , O'Toole R , Singh N , Ajit A , Eze P 
Published: August 2024

Abstract

Introduction
The World Falls Guideline 2022 recommends that measurement of lying-standing blood pressure (LSBP) is an integral part of the multifactorial falls assessment (1). Pre-intervention less than half of eligible patients had a LSBP recorded and documented. The aim was to improve the recording and documentation of LSBP for adults aged 65 and over admitted with a fall or at high risk for falls.

Method
All patients aged 65 and over admitted with fall or identified as at high risk for falls to a care of the elderly ward were included over the period of 15th September 2023-15th November 2023. Royal College of Physicians (RCP) guidance (2017) for standard measurement of LSBP was used2. Data was collected on electronic spreadsheets from electronic observation charts. Two plan do study act (PDSA) cycles were conducted. Firstly, ward posters demonstrated how to record and document LSBP. Secondly ward-based one-to-one teaching interventions using RCP LSBP lanyard flashcards (2) were conducted.

Results
Following cycle one, 50% of eligible patients had LSBP documented. Following cycle two, 80% of eligible patients had LSBP documented. Following two PDSA cycles, there was a 37.1% increase in the average number of eligible patients who had LSBP correctly recorded and documented.

Conclusion(s)
Interventions of aide memoirs and education for nursing and medical staff improved the recording and documentation of LSBP. Indications and correct measurement guidance for LSBP should be included in future ward staff induction information and departmental teaching sessions.

References
1) Montero-Odasso, M, Van der Velde N, Martin FC et al. The Task Force on Global Guidelines for Falls in Older Adults, World guidelines for falls prevention and management for older adults: a global initiative, Age and Ageing, Volume 51, Issue 9, September 2022. 2) Measurement of lying and standing blood pressure: A brief guide for clinical staff. 2017. https://www.rcplondon.ac.uk/projects/outputs/measurement-lying-and-standing-blood-pressure-brief-guide-clinical-staff.
2294 Improving communication and documentation in patients receiving end of life care
Authors: Hal K , Ahmad V , Chatterjee A 
Published: August 2024

Abstract

Introduction
Improvement project in response to several bereavement meetings with families reporting concerns with communication and care received during their loved ones’ end of life care (EOLC).

Methods
Retrospective review of 79 inpatients documentation who died between August 2021–March 2022 in comparison against the Royal College of Physicians National Care of the dying audit to identify targets for intervention. Survey of 22 members of ward staff between (January–March 23) including medical, nursing, and allied health professionals to understand confidence, clinical knowledge and available resources to care for EOL patients and families.

Results
Retrospective audit showed 13.9% of families expressed concerns about EOLC received. Discussions held of the potential for progression into EOLC were 82.4% of cases and that of approaching the terminal phase of life 83.5%, which is similar to the national findings of 83% and 79% respectively. There was an absence in offering holistic support to families and patients like food vouchers, parking permits, and referral to chaplaincy team at only 27.8% cases. This theme was seen in the staff survey, with 16.5% of staff suggesting offering parking permits and 15.2% suggesting food vouchers. The survey also highlighted the relative lack of confidence of allied health professionals 5.9/10 vs the remaining team average of 8.1/10 when providing EOLC.

Conclusions
The audit and survey identified gaps in patient care and communication for our ward staff. To improve quality of care, teaching sessions in collaboration with palliative care team are set to start for ward staff. To improve communication, two proformas were developed; one tackles patient and family communication preferences in cases of acute health deterioration. Another proforma aims to standardise death verification documentation across the trust. These are first cycle interventions to help improve patients and families holistic.
2246 Mind the HAP – an initiative to improve the diagnosis, management and prevention of hospital acquired pneumonia on elderly care
Authors: Nanayakkara T , McLaren C , Miah R , Narayanasamy S , Kobbegala V , Iyer S , Chatterjee A , Faisal K , Black S , Weerasinghe D 
Published: August 2024

Abstract

Introduction
The commonest nosocomial infection in the UK is Hospital Acquired Pneumonia (HAP), associated with prolonged length of stay and mortality. The HAP incidence on Elderly care wards was &gt;5% of admissions, exceeding the national average. An initiative ‘Mind the HAP’ was launched which included doctors, nurses, pharmacists, SLTs, physiotherapists and coders to improve HAP diagnosis, management and prevention.

Methods
To monitor the effectiveness of the interventions 3 audit cycles were performed between 2019 and 2023. Several interventions were implemented between 2019–2023.A multidisciplinary steering committee was formed with 3 work streams (diagnosis, management and prevention). To improve the accuracy of diagnosis and management of HAP, focused educational sessions were conducted for junior doctors with monthly meetings with coders. Nurses championed implementing the HAP prevention strategies i.e. hand hygiene, mouth care and positioning at 30–45 degrees. Regular comprehensive training sessions were held. HAP awareness and education campaign was launched. Daily nursing huddles helped to identify high risk patients. Physiotherapists provide chest physiotherapy to yield sputum sample collection among pneumonia patients. An electronic dashboard of incidence of HAP against the preventative measures and sputum culture reports has been launched with help from informatics. Information leaflets on HAP were created for patient awareness. An electronic HAP power plan to facilitate diagnosis and management of HAP will be launched from February 2024.

Results
HAP incidence has dropped to &lt;2%, diagnostic accuracy improved from 35% to 81%, and sputum collection has increased from 9% to 24%. The HAP Quality Improvement Project received first prize for the most impactful Quality Improvement initiative at the Trust-wide conference in 2023. The results have been shared with the regional Microbiologists.

Conclusion
The collaborative efforts coupled with effective leadership and guidance, have been pivotal to the success of ‘Mind the HAP’ project.
2151 A retrospective analysis of outcomes in inpatient fallers who sustain a neck of femur fracture
Authors: Lee H , Green S , Dickenson C , Russ J , Roberts M , Ng K 
Published: August 2024

Abstract

Introduction
Inpatient fallers make up the minority of neck of femur fractures (NOF) in Morriston Hospital but it was observed that outcomes were less favourable than those in patients who sustained their fracture outside of hospital.

Method
Retrospective analysis was conducted of all NOF patients managed in Morriston Hospital whose injury was the result of an inpatient fall between January 2022 and December 2023. Outcomes were compared to those in all other NOF patients including pathological and occult fractures managed in the centre over the same two-year period. Anonymised data were collected from departmental and electronic patient records.

Results
A total of 1383 NOF patients were analysed of whom 51 sustained their fracture whilst as inpatients across four hospital sites. Among inpatients 35% were identified as requiring supervision when mobilising, the majority required walking aids (73%) and fell on medical wards (65%). Median length of stay prior to falling was 25 days (range 1–171). Patients who sustained a NOF as an inpatient had a lower initial abbreviated mental test scores (p 0.001) and higher frailty scores (p 0.0001) compared to all others, they also had a longer length of stay post injury (Median 23 days vs 17 days p 0.002). Mortality was significantly higher among inpatient fallers Odds Ratio (OR) 4.0 and they were significantly less likely to be discharged to their own home OR 0.3. Post-operative delirium was also seen more frequently OR 2.1.

Conclusion
This data demonstrates that morbidity and mortality is significantly greater among those who fall and sustain a NOF fracture as an inpatient compared to all others. Further work, particularly the timing of inpatient falls in relation to staff handover, is being continued to investigate whether there are any modifiable factors to reduce inpatient falls and the burden of their consequences.
2323 Prevalence of delirium, dementia and cognitive test deficits, hospital-wide and by specialty in &gt; 50,000 unplanned admissions
Authors: Boucher E , Gan J , Shepperd S , Pendlebury ST 
Published: August 2024

Abstract

Introduction
Over one-third of older people with unplanned admissions to hospital are frail, but data on the burden of delirium, dementia and other cognitive frailty are lacking. Reliable hospital-wide and specialty-specific prevalence estimates are needed for service-planning including understanding the role of non-geriatricians in caring for this population.

Methods
ORCHARD includes pseudo-anonymised EPR data for consecutive admissions with a length of stay of &gt;1 day (2017–2019) to four hospitals in Oxfordshire (population = 800,000). Data are collected using a standard cognitive screen comprising dementia history, delirium diagnosis (Confusion Assessment Method-CAM), and 10-point Abbreviated Mental Test-AMTS that is mandated on admission for all patients &gt;70 years. Cognitive frailty was defined as delirium, diagnosed dementia, delirium+dementia or AMTS&lt;8 without delirium/dementia. We analysed the ORCHARD data to determine the prevalence of delirium/cognitive frailty trust-wide and by specialty (n = 29 with &gt;50 admissions).

Results
Among 51,202 admissions with mean/sd age = 82/7 years and Hospital Frailty Risk Score = 8/6, any cognitive frailty was present in 34.5% (95%CI 34.0–34.9%; n = 17,466) of which delirium accounted for 14.6% (n = 7411), delirium+dementia = 9.4% (n = 4757), dementia = 7.5%, (n = 3784), AMTS&lt;8 = 3% (n = 1514). The prevalence of cognitive frailty in general medicine, general surgery and trauma/orthopaedics, which accounted for 80% of admissions (n = 41,016), was 41% (n = 13,879), 21% (n = 801) and 35% (n = 1304) in each, respectively. The prevalence was 44% in geriatric medicine admissions (n = 133/301), 36% in palliative (n = 128/356), 29% in stroke (n = 135/468), 27% in infectious disease (n = 41/152), 22% in neurosurgery (n = 154/702) and 10–20% in all other specialties except two. Delirium was the most prevalent form of cognitive frailty in 24/29 specialties.

Discussion
Cognitive frailty is common in older unplanned hospital admissions across a broad range of specialties, with delirium accounting for most cases. Our findings support the need for hospital-wide and specialty-specific training and service development to reflect the needs of these older complex patients and increased emphasis on delirium in policy.
2245 Disease trajectories and medical expenditures of older long-term care residents in China: prospective observational study
Authors: Zeng L , Tan H , Yang S , Wu J , Dong B , Dou Q 
Published: August 2024

Abstract

Introduction
Global ageing and an increasing disability population impose huge health and economic burdens on societies, and understanding the impact of disability on mortality and medical expenditures among the elderly is vital.

Methods
This study was based on the government-led long-term care insurance program initiated in July 2017 and followed up to June 2021. Diagnosis and hospitalisation costs were extracted from electronic medical records and medical insurance system. The networks of the disease trajectories were established by combining disease pairs with overlapping diseases. Medical expenditures relating to exact disease were calculated and compared between age groups.

Results
The 30,003 participants had a mean age of 79.6 ± 11.1 years, with 57.0% females. After a mean follow-up time of 21 ± 16 months, 17,428 (58.1%) death were observed. Diseases with the highest HRs included septic shock (HR 3.59, 95% CI, 3.36–3.84), respiratory failure (HR 3.19, 95% CI, 3.05–3.34), sepsis (HR 2.98, 95% CI, 2.80–3.18), malnutrition (HR 2.38, 95% CI, 2.27–2.48), and decubitus ulcer (HR 2.27, 95% CI, 2.14–2.41). The disease trajectories were initially related to hypertension and diabetes mellitus, while mortality was associated with malnutrition, infectious diseases, and organic failure. In subgroup analysis, participants with older age, those living in nursing institutions, and males had more complex disease trajectories. The medical costs gradually decreased with increasing age, and there was a rapid increasing trend before death for the decedents. Among the diseases of top 30 frequent hospitalisation visits, intracerebral haemorrhage, sepsis, and respiratory failure ranked as the top three total medical costs.

Conclusions
The study shows that malnutrition and infection-related diseases contribute to death in older disabled and the latter account for part of the highest medical cost, calling for comprehensive strategies for infection prevention and treatment.
2199 The prevalence of pre-admission vitamin D levels in the management and outcomes of proximal femur fractures
Authors: Hunter C , Krishnan S , Ullah A , Rajeev A 
Published: August 2024

Abstract

Introduction
The aim of this study was to examine the prevalence of vitamin D deficiency in elderly patients with fragility fractures of the hip by estimating 25-hydroxyvitamin D levels, whether low levels of Vitamin D at the time of admission affects the functional outcomes and mortality at 28 day and one year.

Methods
A retrospective study of all the patients admitted with a fracture neck of femur from Jan 2018 to March 2021 was carried out. The data was obtained from NHFD (National Hip Fracture Database) and Medway software. A total of 1221 patients were admitted during this period. Patient demographics including age, sex, fracture pattern, Vitamin D levels at the time of admission, function at 120 days, mortality at one month and one year were calculated.

Results
Of the 1221 patients, 106 patients did not have the Vit D levels checked at the time of admission. The average age was 81.91 (range-60 to 108). There were 845 (70%) females and 376 (30%) males. The serum Vit D levels were low in 611 (55.3%) patients. The mobility in patients with Vit D deficiency 261 (40.9%) has dropped significantly in the 3 months after surgery for fractures of proximal femurs. The 28 day and one year mortality was 6.74% and 30.3% compared to 4.7% and 27.3% for those with low and normal levels of vitamin D respectively. Patients with low Vit D levels at the time of admission with proximal femur fractures has got higher 28 day and one year mortality rates compared to those with normal levels.

Conclusion
Our study showed that low levels of Vitamin D at the time of admission with proximal femur fractures are associated with poor functional mobility, higher perioperative and one year mortality.