bluuebunny/crossref_metadata_2025_split huggingface dataset:
2751 Improving identification and Management of Sarcopenia by physiotherapists in older People’s medicine
Authors: Buckland C , Campbell N , Callender J , Bennison S 
Published: January 2025

Abstract

Introduction
Sarcopenia is common in hospitalised older people and is associated with unfavourable health consequences. Identification of sarcopenia risk with the offer of resistance exercise are key to improving outcomes and recommended in clinical practice guidelines. Previously, there was no sarcopenia testing on Older People’s Medicine (OPM) wards highlighting a need for local improvement. This project seeks to translate and implement best practice to determine the possibility for physiotherapy staff working in OPM to offer a sarcopenia intervention as part of discharge planning. Improving sarcopenia care can help an ageing population maintain health and independence, bringing benefits for patients and the healthcare system.

Project aim
Within 3 months, to achieve a 50% increase in the number of patients offered a sarcopenia intervention.

Methods
Using the ‘Plan-Do-Study-Act’ approach, a sarcopenia assessment and therapy intervention was developed and introduced as part of the discharge process on an OPM ward. Measures: The weekly number of patients with a documented offer of the sarcopenia intervention was collected over 13 weeks and evaluated on a run chart. Cohort data were also recorded and described using descriptive statistics.

Results
At baseline, 0 patients were offered the sarcopenia intervention, this improved to 59/87 (68%). The mean age was 83 years (range 66–97) and 53 (90%) consented to be tested for sarcopenia; grip strength was measured in 51 (96%) and standardised 5*sit-to-stand in 5 (9%), with the latter typically not measured without upper limb support. There was a high prevalence of probable sarcopenia, (49 [92%]); 41 (84%) of those accepted the therapy intervention.

Conclusions
Physiotherapy staff can offer a sarcopenia assessment and therapy intervention as part of discharge planning of older people from hospital. Implementation may help to support older people to recondition after hospitalisation and achieve better health outcomes. Resources are necessary for sustainable and scalable application.
2755 The use of serum procalcitonin testing in hospital inpatients over the age of 80 years old
Authors: Clarke G , Green S , Ragunathan J , Subudhi P , Patel R 
Published: January 2025

Abstract

Introduction
Serum procalcitonin levels increase in response to bacterial infections and decrease with successful treatment. Procalcitonin can, therefore, inform decisions around antibiotic use. For adults with suspected infection, using procalcitonin to start antimicrobials is not advocated but serial testing is suggested to aid with the decision to discontinue therapy.

Methods
A retrospective study was performed of adults over the age of 80 years admitted on a medical ward who had a serum procalcitonin completed between November 2022 and April 2023. Their electronic patient records were reviewed, with data collated and analysed using Microsoft Excel.

Results
Of 160 patients studied, median age was 85 with a median clinical frailty score of 6. The suspected sources of infection for the patients were chest (65%), unknown source (22.5%), urine (5%), cellulitis (3%), biliary (1.3%), osteomyelitis (1.25%), abdomen (0.63%) and infected haematoma (0.63%). Confirmed viral respiratory infection was present in 76 (47.5%) patients. Of all patients, only 62% were taking antibiotics at the time the procalcitonin was taken. Only 4 patients (2.5%) had serial procalcitonin testing (24–48 hours apart).

Conclusion
Procalcitonin was more likely to be used for suspected respiratory tract infection than other suspected infections. The majority of patient were taking antibiotics at the time the test was performed, which would indicate the tests being used to support a diagnosis of bacterial infection. Only a minority of patients (2.5%) had more than one procalcitonin result indicating that the clinical utility of this blood test to aid decision making in altering antimicrobial therapy was not occurring. Therefore, procalcitonin testing within an older adult population is being used in an inappropriate manner in the context of infection. Given a cost of £39.50 per test we anticipate that in its current use procalcitonin testing is not being used in a cost effective or clinically effective manner.
2761 Proactive care in independent living facilities—reducing unplanned demand on the health economy
Authors: Coleman-Jones EJ , Evans P 
Published: January 2025

Abstract

Introduction
The Chandlers Ford, Eastleigh and Southern Parishes Frailty Support Team (FST) identified pockets of high referral rates within independent living facilities. It was hypothesised that this may be because independent living facilities do not have a contractual arrangement for proactive intervention, unlike care homes and nursing homes. This leaves individuals and carers unsure how, when and where to seek support. In turn, this potentially has a high healthcare burden through unplanned access to GP’s, 999, 111 or admissions to hospital.

Methods
An independent living facility was identified, and participants were invited to have a proactive, holistic review. Medical notes were reviewed for 12 calendar months prior the project and all unplanned contacts recorded. Each participant then received a face-to-face review which identified, addressed and rectified any findings/concerns. A follow-up review of medical notes and a telephone call to participants was completed 3 months later.

Results
This project has decreased unplanned medical contacts by an average of 85% in all participants which equates to an average saving of £453.67 per person.

Conclusions
The project suggests that in independent living facilities switching from a reactive to a proactive model may allow for better holistic care, in turn reducing the burden on the local health services. It is acknowledged that this is a small sample and therefore may not be representative or generalisable and a larger study is recommended.
2782 Don’t panic! How acute kidney injury and hyponatraemia can be safely managed on a frailty virtual Ward
Authors: Gibbons C , Alexander H 
Published: January 2025

Abstract

Introduction
Acute kidney injury (AKI) and hyponatraemia are common causes for hospital admission for frail, elderly people. Some patients could be managed at home using the Virtual Ward model, reducing risk of healthcare related adverse events. We aimed to show plausibility for this treatment model.

Method
We produced guidance for managing patients with AKI/hyponatraemia on the Frailty Virtual Ward (FVW). We then collected data from patients treated for AKI (N = 12) and hyponatraemia (sodium &lt;126 mmol/L) (N = 9) and compared with a similar inpatient cohort (AKI N = 14, hyponatraemia N = 16). FVW patients received remote vital signs monitoring, telephone consultations and blood tests.

Results
AKI: FVW patients had creatinine rise 30–101%, and pre-renal AKI. They had fewer adverse events and none died. None required intravenous therapy or Renal input. Most fully recovered by discharge, whilst some established a new creatinine baseline, and had community follow-up. Inpatients had more severe AKI and frailty contributing to higher mortality and adverse events. Hyponatraemia: FVW patients had asymptomatic/chronic moderately-severe hyponatraemia (sodium 120-126 mmol/L). The most common cause was SIADH. They were less likely to undergo hyponatraemia investigations, but more likely to receive an explanation for hyponatraemia. They had fewer healthcare associated adverse events, readmissions, or deaths. Inpatients were more severely unwell. Three FVW patients received Endocrine opinions. Most FWV patients recovered (sodium &gt;125 mmol/L), except one who was admitted (sodium 120 mmol/L) and one who had a follow-up plan for sodium 124 mmol/L.

Conclusion
Mild AKI and moderately severe chronic/asymptomatic hyponatraemia can be managed under the Frailty Virtual Ward model with few adverse events compared with inpatient care. Underlying causes often require minimal medical intervention, such as medication review or fluid restriction. Specialist input is still possible. Work is needed to ensure FVW patients receive the same level of investigation as inpatients, and that they have a clear follow-up plan.
2851 Reducing the number of unplanned admissions to hospital through a multidisciplinary single point of access pre-hospital
Authors: Sage S , Baxter A , O’Riordan S , Seeley J , McGarvey J 
Published: January 2025

Abstract

Background
East Kent has 38,101 people over 80 years, 39, 021 living with moderate or severe frailty and 304 care homes. This population have high levels of unplanned admissions which can put them at risk of long hospital stays, reduced mobility and increased delirium. East Kent Ambulance services (SECAMB), Acute hospitals (EKHUFT) and Community Services (KCHFT) have piloted a single-point of access consisting of an ED consultant, community frailty clinician, Urgent care senior nurse, advanced paramedic practitioners. They sit together at the ambulance bases, 10 am-6 pm Monday to Fridays. This team reviews all patients awaiting ambulances to assess whether there are alternative services to ED which would meet the individuals’ needs.

Method
The MDT assesses all patients listed as awaiting an emergency ambulance. Clinical records can be accessed from all services including GP records. If patients would benefit from treatment by alternative services, rather than conveyance, the paramedics are asked to call the MDT. This allows clinical assessment, history and investigation results to be taken into account in planning care. Patients and Carers are involved in deciding how they would like to receive medical care via a video or phone link with clinicians.

Results
Conveyance to hospital pre pilot 62% post pilot less than 50%. Ashford catchment: admissions save weekly 27.3, bed days saved weekly 179.2. Thanet Catchment: admissions saved weekly 19.1, bed days save weekly 106.9.

Conclusion
Many people can be treated effectively without conveyance to hospital through pre-hospital triage, consultation and planning by senior clinicians in a multi-disciplinary team.
2890 Exercise practitioner-led physical activity in hospitalised older people: saints foundation—university hospital Southampton
Authors: Draper P , Batchelor J , Diamante N , Hedges P , Gealer M , McCafferty R , Leli H , Patel HP 
Published: January 2025

Abstract

Introduction
University Hospital Southampton (UHS) and Saints Foundation (SF) have partnered to test and deliver rehabilitation to hospitalised older adults via a non-registered Exercise Practitioner (EP) to promote physical activity (PA) and address hospital associated deconditioning. Now in its third phase, the project has evolved in response to patient and staff feedback. It delivers regular gym-based exercise classes and additional interventions, which have maintained or improved patients’ dependency levels on discharge.

Method
From September 2023, the EP has delivered daily gym-based group interventions as well as 1:1 rehabilitation to hospitalised older adults. In addition, exercise prescription education for staff and signposting to community-based interventions is provided. Interventions take place in the acute therapy gym or wards.

Results
Between October 2023 and February 2024, the EP reviewed 115 patients, with a mean age of 86 yrs. 90 (78%) underwent group-based intervention whereas 25 (22%) received 1:1 input. 100 (87%) patients maintained or improved their predicted to actual discharge destination, compared to 13 (11%) whose physical capability declined and 2 (2%) who died. 20 (17%) were readmitted within 30 days of discharge. Elderly Mobility Scores (EMS) improved from a mean of 13.42 to 13.97. Most patients were reviewed twice or more. Most patients (79% after 2 interventions) maintained a 4 m gait speed score of &gt;0.8 m/s. Patient satisfaction and confidence in function rated high.

Conclusion
Intervention via a non-registered EP continues to have a positive impact on older adults’ ability to maintain or improve function during an acute hospital stay. Factors such as outbreaks of infectious illness, staff absence and vacancies and high patient acuity prevent more frequent EP led intervention. Although overall strength and functional gains are limited, patient confidence in function remains high. Our future aim is to expand the project across UHS and bridge the gap to community rehabilitation services.
2765 Reducing avoidable discharge delays on an elderly admissions Ward
Authors: Newton-Clarke A , Atkinson M , Shelton K , McDaniel S 
Published: January 2025

Abstract

Introduction
Our aim is to improve clinical efficiency by reducing avoidable discharge delays, increased number of discharges and availability of specialist Frailty beds. We intend to undertake 8 PDSA cycles with a new idea.

Background
23 bedded Acute Frailty Short Stay Unit (AFU). Patient group defined as those admitted to the unit from April ‘24 to current. Our initial spot-audit analysed 18 patients; the mean total avoidable delay was 31.52 hours (range 4.73–123.3 hours). Initial analysis demonstrated that delays became longer throughout the course of the day.

Methods
We evaluated staff opinions on the discharge process with a survey. Outcome measure identified as number of weekly discharges and appropriate patient flow to the AFU. Balancing measure identified as number of readmissions within 48 hours. PDSA cycle 1 allocated a doctor to write discharge letters during MDT. PDSA cycle 2 allocated a suitcase symbol to a potential discharge in the next 24 hours. We then adapted the suitcase with colours to differentiate between ready and awaiting investigations/aim home in 24 hours. The next involved allocating a discharge doctor to review patients with an amber suitcase from the previous day first.

Results
Initial staff feedback has been positive. Data demonstrated an increase from the baseline (from below 20 to an average of 25 discharges a week). This then dipped throughout May, during which time there was an unusual level of escalation, staff absences and annual leave. The data has begun to recover to a high of 27 discharges in the week of the start of June.

Conclusions
Utilising the MDT has been vital in the sustainability of the project. On-going staff surveys and regular meetings will help to ensure sustainability. Ongoing focus and further cycles are on encouraging junior members of the team to be involved with the intervention.
2780 Avoiding acute admissions by working in a multi-disciplinary team alongside paramedics in the West Kent clinical navigation hub
Authors: Heskett A , Mummaneni J , Hicks W 
Published: January 2025

Abstract

Introduction
Home Treatment Service (HTS, a Frailty Hospital at Home model that provides Comprehensive Geriatric Assessment, diagnostics and treatments to avoid hospital admission for people with frailty) within Kent Community Health NHS Foundation Trust has increased links with the Acute and Ambulance Trusts. The MDT interacts with visiting paramedics within a clinical navigation hub (CHUB).

Method
61 HTS referrals from the CHUB were compared with 61 direct clinician referrals from December 2023 to February 2024. The NEWs score, length of stay (LOS) and Advance Care Planning (ACP) documents were analysed.

Results
The average LOS under HTS via the CHUB was 2.61 days and 3.65 days for direct referrals. 27% of NEWS scores from the CHUB were high compared with 14% from direct referrals. 48 out of the 61 (78.6%) patients identified as requiring HTS by the CHUB had no ACP documents (the presence of a DNAR was not counted as this does not give community options). 37 out of 61 (60.6%) had no ACP on direct referral to HTS triage.

Conclusion(s)
Referrals directed to HTS proactively from the CHUB have a higher percentage of NEWS scores that would require hourly observations and/or escalation to medical assessment. The CHUB explores community options while weighing benefits and risks of transfer to hospital in real time. The LOS between the two referral sources is not hugely different and suggests that we are identifying patients requiring similar management regardless of source of referral. The CHUB gives options to patients who have fewer advance decisions recorded to support the direction of their care at the point of an emergency response. The CHUB allows HTS to access a different group of patients who may not have had routes to HTS enabled previously.
2812 Local radiological reporting of vertebral fragility fractures: a missed opportunity for early osteoporosis intervention?
Authors: Ali F , Obasi E , Burger R , Rodwell-Shah S 
Published: January 2025

Abstract

Introduction
Vertebral fragility fractures (VFFs) are the most prevalent form of osteoporotic fracture, with an incidence of &gt;20% in women &gt;70 years old1. While often clinically silent in isolation, VFFs are associated with future osteoporotic fractures, decreased quality of life and an 8-fold increase in age-adjusted mortality2. Radiologists may facilitate early diagnosis of VFFs, allowing for more cost-effective intervention with greater patient outcomes 3. However, a national audit in 2019 demonstrated widespread failings in the radiological recognition and reporting of VFFs1, according to criteria outlined by the Royal Osteoporosis Society4. Crucially, only 2% of reports in patients with moderate–severe VFFs recommended referral to Fracture Liaison Services (FLS), compared to the national target of 100%. Here, we evaluate local VFF recognition and reporting performance, relative to the Royal College of Radiologists (RCR) targets5.

Methods
Single-centre retrospective analysis of all CT thorax, abdomen and pelvis scans in &gt;50-year-olds. Two cycles were completed, with implementation of educational posters and a quick-code reporting alert between cycles. The proportion of reports meeting best practice criteria were measured. The criteria included: assessment of bony integrity (target 100%), correct identification of moderate–severe VFFs (target 90%), use of correct terminology in reports (target 100%), referral of moderate–severe VFFs to the FLS (target 100%).

Results
Bony integrity was assessed in 100% in both cycles. Identification of moderate–severe VFFs improved from 37% to 64% between cycles. Correct terminology was used in 63% and 56% of reports in the first and second cycles respectively. 0% of patients were recommended for FLS referral in both cycles.

Conclusion
This audit demonstrates local shortcomings in VFF recognition and reporting. While there was an improvement in identification of VFFs between cycles, RCR targets were still not met post-intervention. This reflects a nation-wide issue in the under-diagnosis.
References available on request.
2608 Improving the uptake of telephone interpreter Services for non-English Speaking Patients in South Yorkshire
Authors: Srivastava N , Pinidiya J , Marsh J 
Published: January 2025

Abstract

Introduction
Language is a social determinant of health, as constituted by the World Health Organisation (WHO) back in 1948. UK migration rates have risen exponentially recently, and with it the inability for patients to speak functional English is a growing concern. Poorer health information and avoidance of service use creates fundamental health inequity within this demographic. The UK’s ever-changing sociodemographic landscape necessitates a growing focus on health outcomes within non-English speaking patients.

Aim
To explore the barriers towards interpreter service use within South Yorkshire and how to improve communication with non-English speaking patients.

Method
Data was collected in a mixed quantitative-qualitative approach. A yes/no approach was adopted to answer the study objectives (i.e. whether family members had translated on behalf of relatives or if interpreter service use was documented). Observational comments from the notes were used to contextualise the data for further discussion. This was compared to available UK guidelines.

Findings
There was a widespread reliance on family members to interpret on patients’ behalf, seen in 75% of non-English speaking patients on the sampled wards. Only 50% of these patients had documented use of interpreter phone lines across the wards, significantly below the audit’s standards.

Discussion
Barriers to interpreter services may be attributed to inefficiencies within its online nature, including queues and connectivity issues. This discourages its uptake, especially in the face of increasing hospital pressures. The high reliance on family members requires ethical considerations. These include issues with confidentiality, poor safety netting and disjointed communication of diagnoses when family members are used to translate. Ultimately, reliance on family members should be actively discouraged. This project recommends a language assessment tool and identification charts to guide NHS staff to appropriate interpreter services, preventing care delays.
2731 Evaluation of practice of advanced care planning in GIM wards in Queen Alexandra Hospital/Portsmouth hospitals university trust
Authors: Yahia G , Almoukadem M , Kanaan A , Hasanli E 
Published: January 2025

Abstract

Introduction
In today’s healthcare practice, many patients live longer with multiple health issues, often in a frail or terminally ill state. Their quality of life doesn’t necessarily improve. These patients require optimal supportive care that respects their dignity. Advanced Care Plans (ACPs) are crucial here, facilitating person-centred discussions about future care preferences while the patients have the mental capacity for meaningful participation. We aim in this study to assess how many patients in General Internal Medicine department would benefit from ACP and compare that to our current practice in implementing ACPs.

Method
This cross-sectional retrospective study was done in 2 instances, 1 month apart from 29/03/23 to 01/05/23. The Sample size was 300 patients. The eligibility criteria were life expectancy of 12 months or less, age of 80 years and above, Clinical Frailty Scale (CFS) 8 or more, advanced dementia, and end-stage disease.

Result
33 patients (11%) met the eligibility criteria for ACP. 8 patients (24.2%) were above the age of 85. 25 patients (75.8%) had a Clinical Frailty Scale score higher than 7. 12 patients (36%) had terminal cancer. ACP was done for only 6% of the cases that meet the eligibility criteria. Within three months, 90% of these cases passed away. It is important to mention that in 57.6% of the cases, ACP was discussed with the patient and the next of kin (NOK) but was not formally documented.

Conclusion
Our findings revealed that only 6% of the eligible cases had evidence of ACP. This aligns with the study ‘advanced care planning in patients referred to the hospital for acute medical care: Results of a National Day of Care survey’ which showed 4.8% had an ACP. The absence of ACP in the vast majority of re-admitted patients represents a significant missed opportunity to improve care.