bluuebunny/crossref_metadata_2025_split huggingface dataset:
1805 The importance of ongoing awareness and education for Lying and Standing blood pressure (LSBP) during hospital admissions
Authors: Bendahan D H , Mitchell C , Chauduri S , Wing J , Bird B , Safeer S , Hota S 
Published: January 2024

Abstract

Introduction
Inpatient falls remain a huge problem in hospital, causing significant injuries to patients and are an avoidable cost to the NHS. Therefore, the National Audit of Inpatient Falls (2015-2017) set out key recommendations for management of falls, including the measurement of LSBP within 3 days of hospital admission.

Method
Our project was conducted in a major acute teaching hospital in North West London across three geriatric wards. Our aim was to improve the measurement of LSBP and correct documentation across the wards in line with the NAIF guidelines. We excluded patients unable to mobilise to standing with support, patients too unwell or unable to follow instructions and actively dying patients. Prior to any intervention, we found that only 24% of patients had LSBP performed within three days of admission. We focused our intervention in raising education and awareness across our staff. We arranged weekly reminders during MDT meetings, created posters and organised twice monthly teaching sessions, including one to one, on how to document correctly electronically.

Results
After one month of intervention, 73% of patients had LSBP as part of the ward round plan and almost half of patients had it correctly recorded on our system. After 4 months, we reaudited our project and found that only 32% of patients had LSBP appropriately recorded. This significant decrease can be explained by the changeover of junior doctors and emphasises the need of a more sustainable change.

Conclusion
Our goal is making LSBP part of a routine preadmission checklist when appropriate. We are currently working on making changes to our electronic patient record (EPR) to facilitate documentation to members of staff. This includes a new falls assessment tool and the newly incorporation of Smartzone feature on EPR. This will allow staff to put non-critical jobs in the workflow showing a less intrusive alert until completed.
1733 An itemised discharge letter format improves clarity of information - a quality improvement project
Authors: Macaulay J , Wear H 
Published: January 2024

Abstract

Introduction
Commonly, discharge letters employ a chronological “narrative” style (NS). These unstructured letters often do not clearly communicate rationale for diagnoses and management – a problem exacerbated in letters compiled by multiple staff. This project trialled an alternative format.

Methods
An itemised letter (IL) was designed, each diagnosis a separate numbered point; guidance was provided for relevant investigations and management to include for core geriatric conditions. Four “Plan Do Study Act” (PDSA) cycles were completed. Mixed-methods feedback informed subsequent cycles. PDSA cycle 1 piloted the IL. Responding to concerns ILs took longer, cycle 2 measured writing times on a second ward. Cycle 3 monitored spontaneous IL uptake and feedback throughout geriatric medicine, continued in Cycle 4 after 12 months when the department formally adopted ILs.

Results
We collected 17 email responses, 9 semi-structured interviews, 1 tweet, writing times, and uptake statistics. Framework analysis synthesised qualitative and quantitative results. The key finding was that ILs improved information clarity. The standardised structure made it easier to update letters, and teach letter writing to new staff. Some staff reported challenges changing letter format, and noted electronic templates were not optimised for ILs. Mean completion times were 23 minutes for IL (range 6.5–38, N=15) and 20 minutes for NS (15–26, N=5). Sample size imbalance reflected exclusion of letters, predominantly NS, started on other wards. Uptake data evidenced continued IL use despite staff rotations. When cycle 4 commenced a mean of 35% (range 0–91%) of letters were in IL, increasing after seven months to 64% (40.6–90%). Qualitative feedback mirrored on-going usage, with many doctors continuing IL use after rotation. PDSA cycle 5 has begun, discussing using ILs in other specialties.

Conclusions
The IL format was well received by hospital staff, and will be improved by feedback from GPs, relatives, and patients.
1959 De-prescribing within the East Kent Community Frailty Team: assessment of medication review processes and potential cost-savings
Authors: Jones A J D , Bristow-Smith M 
Published: January 2024

Abstract

Introduction
Older people living with frailty are often prescribed many medications exposing them to potential medicine-related harm. Pharmacists are a new addition to the East Kent Community Frailty Team, which otherwise consists of doctors and advanced clinical practitioners at various levels of training. Pharmacists are ideally placed to develop medication review processes and support fellow clinicians with deprescribing efforts in frailty. This audit set out to determine current levels of medication review and associated cost-savings through deprescribing.

Method
All patients admitted to the frailty team caseloads in the month of May 2023 had their notes manually reviewed for evidence of medication reconciliation, review, and deprescribing. Medicines were assigned a cost price based on the NHSBSA Drg Tariff (May 2023).

Results
192 patients were seen in total, 170 of whom were acutely unwell. 62% of patients had their medication documented, taking an average of 8.2 medicines. The majority of omissions were patients with a zero length-of-stay, which include advice calls. 29% of patients had at least one medication stopped, representing an average 0.7 medicines stopped per patient seen. The monthly cost of medications stopped was £690. There were greater levels of deprescribing in the caseloads with MDT board rounds.

Conclusion
Rates of deprescribing are low compared to published studies (Ibrahim et al, BMC Geriatr 21, 258 (2021)), although still represent a rolling saving of approximately £8,000 per month on cost of medicines alone, assuming a twelve-month average life expectancy. Lack of standardisation of clinical notes and documentation made data collection difficult and has the potential to lead to transfer-of-care errors. Further work needs to be undertaken to optimise the medication review process and address inappropriate polypharmacy and will be the focus of efforts over the coming year.
1899 Early intervention by physiotherapy and occupational therapy in older inpatient population
Authors: Kotak S 
Published: January 2024

Abstract

Background
Currently, on inpatient medical wards at University Hospitals of Leicester NHS Trust, first contact by physiotherapy and occupational therapy is made when patients become medically optimised for discharge. This is due to a number of reasons such as staffing and resource shortages.

Aim
Analyse the effects of early intervention by therapy on patients on a geriatric medicine inpatient ward. It is hypothesised that earlier intervention can improve patient and service outcomes.

Method
A data sheet was created to capture baseline information including mobility/care needs prior to admission, date of initial contact by therapy, mobility/care on discharge, length of stay and discharge destination. Data was collected over two phases; initial therapy contact at point of patient being medically optimised, and then with the planned intervention of proactive therapy input early in a patient’s admission.

Results
The data shows an improvement in all measured patient outcomes in the intervention group. The average time from admission to therapy first contact reduced from 7 days to 2 days. The average length of stay reduced from 14.5 days to 7 days in the intervention group. 70% of patients left the hospital with a reduction in their mobility status in the control group, whereas only 32% of patients left with worse mobility in the intervention group. 41% of patients in the control group left with new or increased care provision compared to 36% in the intervention group. The data also showed that a higher proportion of patients were mobilised by ward staff and less patients were discharged to 24-hour care settings in the intervention group.

Conclusion
Therapy (with the help of the multi-disciplinary team) should proactively identify patients in need of therapy input as soon as safely possible. This research shows that adopting this approach leads to improvements for our patients and our service.
1849 Implementing a comprehensive geriatric assessment (CGA) in older adults presenting to a district general emergency department
Authors: Niranjan D , Findlay A , Joomye S , Carolan C , De Bhaldraithe S , Rabia M Abu 
Published: January 2024

Abstract

Introduction
Frailty is the concept of increasing vulnerability to minor stressors in the context of a reduction in physiological reserves (Clegg et Al. The Lancet 2013, Volume 381, pages 752-762). It affects 10% of people presenting to Emergency departments (ED) and around 30% of inpatients in acute medical units (NHS England and NHS Improvements. 2019). Implementing a CGA is known to result in a significant increase in your likelihood of being alive and in your own home at 6 months (Ellis et Al. BMJ 2013).

Aims
To implement an ED in reach frailty service with the goal of performing a CGA at the earliest opportunity.

Methods
We undertook a 3-week pilot with a small team comprising a consultant, frailty ACP, SHO and geriatric registrar. The team were based in ED and worked alongside the existing ED navigator team and in conjunction with various community teams. Data was collected assessing completion of the usual domains within the CGA and discharge data.

Results
62 patients were seen in total. Mean age was 82.4 years with a mean CFS of 5. Each patient received a CGA. 9/62 (15%) of patients were discharged on the same day. 15/53 (28%) were discharged within 72 hours of admission. Other notable results include: 100% completion of 4AT and 70 medications de-prescribed. Feedback from patient and relatives in addition to ED and AMU doctors was extremely positive.

Conclusion
We demonstrated that performing a CGA in ED resulted in higher numbers of patients being discharged on the same day or within 72 hours of admission. We were able to demonstrate a significant increase in assessment of delirium allowing earlier detection and a much higher rate of deprescribing with significant benefits for both patient and the trust.
1949 Improving the utilisation rate of ‘hot slots’ in an outpatient frailty service
Authors: Shekarchi-Khanghahi E , Morelli F , Smith N 
Published: January 2024

Abstract

Background
North Middlesex University Hospital runs an outpatient frailty service where patients are referred for a Comprehensive Geriatric Assessment. There is a daily ‘hot slot’ for patients who otherwise would have required hospital admission if not seen within seven days. We aimed to improve utilisation of hot slots from 50% to 100%. Empty hot slots result in the under-utilisation of pre-allocated resources and increase the workload of healthcare professionals in other departments.

Methods
Author ESK audited hot slot usage in November and December 2022, marking slots as ‘filled’ or ‘unfilled’. In January 2023 we established a clear referral process for the hot slots and implemented an education program targeted at referrers to increase awareness of the availability of hot slots and referral criteria. Authors ESK, NS and FM re-audited the hot slot usage from February to April 2023. Author FM analysed the data and conducted statistical testing of the results. Authors NS and FM produced visual representation of the data collected.

Results
After exclusion of periods where the hot slots were closed (n=13) including strike days, bank holidays and times with below minimum staffing; 82 hot slots were audited, pre-intervention (n=39) and post-intervention (n=43). The utilisation of hot slots increased from 51% pre-intervention to 86% post-intervention. Fisher's exact test shows this is statistically significant (p&lt;0.0007).

Conclusions
The education program increased utilisation of hot slots but fell short of the targeted 100% utilisation rate. We made the hot slot available exclusively to the Geriatric Emergency Medicine (GEM) team for one week in August 2023 to assess whether this increases GEM utilisation of the hot slot. We intend to further analyse the data to review the appropriateness of referrals and try to improve this. A larger project could assess impact of hot slot usage on patient outcomes.
1689 Establishing an oncogeriatric multi-disciplinary team (MDT) and accompanying clinic at a DGH in Somerset
Authors: Parker H , Birchenough S , Cattell E , Barthakur U , Woodhill S , Foster M 
Published: January 2024

Abstract

Introduction
Recent studies show the use of comprehensive geriatric assessment (CGA) in older patients with cancer can result in better quality of life, improved treatment tolerance and reduced hospital admissions, leading to international consensus that CGA should be routinely included in care. We have piloted an onco-geriatric MDT, consisting of oncologists, geriatricians and therapy input, alongside a rapid-access geriatrician-led onco-geriatric clinic

Method
Referrals were invited from oncologists for older patients (&gt;70) with a new diagnosis of cancer, with expected prognosis of more than 1 year, about whom they had concerns regarding their ability to undergo radical treatment due to co-morbidities, falls, cognitive impairment or social isolation. A CGA was completed prior to starting radical treatment in most cases. Performance status, Rockwood frailty score (RFS) and G8 score were calculated for all patients.

Results
During the 24-week trial period, an MDT and clinic has run every week. A total of 32 patients have been discussed at MDT, with 22 seen in clinic, from cancer sites including colorectal, breast, urological and ovarian. Patient seen in clinic had an average RFS of 4.5 and G8 score of 13. All patients have seen a geriatrician, with most also seeing our physiotherapist. Interventions included medication review and rationalisation, anaemia review and treatment, referral to specialist memory and continence services, blood pressure optimisation and completion of a treatment escalation plan.

Conclusions
Feedback from patients attending the clinic has been resoundingly positive, with 100% of patients rating their service experience as “good” or “very good” and praising the time to talk about their health as a whole. Follow up of clinic patients is in progress, identifying emergency admissions alongside treatment toxicities and complications within this group, as well as whether G8 is an appropriate screening tool for clinic review, to secure the long-term future of the service.
1896 Community geriatrician led memory service improving access to dementia diagnosis with focus on admission avoidance
Authors: McCarthy M , O'Donnell C 
Published: January 2024

Abstract

Introduction
The Community Geriatrician team based at the Countess of Chester Hospital is a multidisciplinary team offering comprehensive assessments at home to older patients with frailty. The team review frail patients identified as being at risk of hospital admission. Cognitive impairment and dementia are increasingly common concerns in our patient group and significant risk factors for admission. Frail patients often struggle to access traditional memory clinics for a variety of reasons and can therefore remain undiagnosed. They often require a more holistic approach in their home environment. We therefore identified a need to offer a dedicated frailty memory pathway within our community geriatrician team enabling better access to dementia assessment and diagnosis in complex frail patients.

Method
A frailty memory assessment pathway was proposed and commenced in 2022. Following identification of a cognitive concern during the initial comprehensive geriatric assessment a further home visit is arranged to assess memory in more depth. Patients are then discussed, and a diagnosis reached via a monthly Frailty memory MDT attended by a consultant psychiatrist, consultant geriatrician, and specialist occupational therapist. Following delivery of a diagnosis our AGE UK well-being coordinator within the team provides post diagnostic support and sign posting to patient and family. A retrospective audit was undertaken reviewing the 44 patients diagnosed since pathway commenced. The number of hospital admissions and number of inpatient bed days was compared in the 3 months pre and post initial assessment.

Results
In the 3 months following assessment, 82% of patients had a reduction or unchanged number of admissions, there was a total reduction of 71 inpatient bed days.

Conclusion
We believe our pathway offers a unique multidisciplinary approach to dementia diagnosis in the frail population, improving frail patients access to dementia assessment with a reduction in hospital admissions.
2026 Development of a novel 2-week wait oncogeriatric service: A GI Frailty Clinic
Authors: Dinsdale E , Whitehead K , Gould D , Miller C , Nair S 
Published: January 2024

Abstract

Introduction
Over the last 12 months, a novel oncogeriatric clinic was successfully established to assess frail 2-week wait (2WW) patients referred with gastrointestinal (GI) symptoms. The clinic was initially funded by the West Yorkshire Cancer Alliance, enabling a weekly clinic, run by a geriatrician, clinical specialist nurse and an advance clinical practitioner.

Methods
A total of 350 patients were assessed (those with a clinical frailty score of ≥ 6 were eligible for referral); due to demand exceeding capacity, remaining patients were referred on through the default surgical or GI pathways. Patients were triaged by endoscopy nurses from ‘straight to test’ referrals after training provided to assess frailty scores using routinely available data.

Results
Only a third of patients referred remained on the 2WW pathway compared to surgical patients; this was due to patients being too frail or an alternative diagnosis being made through comprehensive geriatric assessment, and a shared decision-making process. The patient level information and costing system (PLICS) demonstrated that the oncogeriatric clinic was cost effective, costing approximately £190 less per patient than the default pathways of care. Feedback from patients demonstrated extremely high satisfaction rates with the service provided. One of the most significant interventions was medicines management, which has led to a pharmacist supporting the clinic through further innovation funding.

Conclusion
Lessons learned included developing a better understanding of cancer diagnosis and frailty, providing a ‘one stop centre’ for cancer care, and managing complex comorbid conditions in frail older people suspected of having cancer. As a result of this QI service development project, a Frailty Cancer Strategy for the Trust is currently being developed and will be presented to the executive team with the aim of developing a comprehensive oncogeriatric service for frail patients in Leeds, providing the right care, the right treatment, first time.
2008 Improving the documentation of Treatment Escalation Plans in patients &gt;65yo admitted under the care of orthopaedics
Authors: Quarm M , Turnbull J , Stirzaker A G 
Published: January 2024

Abstract

Introduction
Treatment Escalation Plans (TEPs) are helpful tools that reduce un-necessary treatment burden, improve patient experience and follow the principles of realistic medicine. This is relevant in orthopaedics where a high percentage of the patients are frail, co-morbid, and would benefit from clear and realistic care plans. We aim to improve TEP completion to &gt;50% of orthopaedic patients, over the age of 65yrs old, in three trauma wards at the Royal Infirmary of Edinburgh by August 2023.

Methods
We sampled three patient notes on each ward twice weekly from May – August 2023, noting whether TEPs were present, if it was consultant endorsed or provisional, and what key sections were completed (resuscitation, treatment goals and communication). To be included, the patient had to ≥65 and under orthopaedics. Process mapping demonstrated 2 key targets- admission clerk-in and registrar review. PDSA 1 involved creating a prompt for documenting TEPs on FY1 clerk-in which was added to the admission proforma folder and displayed as posters. PDSA 2 was a teaching session designed for orthopaedic registrars and other team members about TEP conversations.

Results
Pre-intervention data, demonstrated a median of 28% of orthopaedic patients ≥65yo have a TEP. Of the completed TEPs: 88% solely consisted of a resuscitation decision; 33% had treatment goals, 33% communication; and 0% of TEPs were endorsed. After PDSA 2; median TEP completion increased to 33%. Of the completed TEPs; none had only a resus decision, 100% have treatment goals; 100% communication, and 67% are endorsed.

Conclusions
Our studies have demonstrated that education and proforma changes have increased TEP documentation rate, although not to our projected target. However importantly, the percentage of TEPs that contain goals, document communication and consultant endorsement has improved significantly. This project is ongoing with planned further PDSA cycles.
1880 Improving physical activity in hospitalised older people: The Saints Foundation - University Hospital Southampton Partnership
Authors: Batchelor J , Hedges P , Gealer M , McCafferty R , Leli H , Draper P , Patel H P 
Published: January 2024

Abstract

Introduction
Deconditioning in the acute setting is associated with adverse outcomes, that cannot always be mitigated by increasingly stretched MDT workforce. We partnered with the Saints Foundation (SF), to test the feasibility and acceptability of a non-clinical Exercise Practitioner (EP) to work alongside therapies to promote physical activity (PA) of hospitalised older people.

Methods
Charity funded joint appointment of an NVQ3 EP with Postural stability Instructor (PSI) qualifications delivered quality education and rehabilitation programmes to hospitalised older patients. These took place in both one to one and gym-based group settings whilst working with the SF team to improve access to community-based exercise programmes.

Results
Between Sept 2022 and May 2023, the EP assessed 169 patients, mean age 86 yrs; male (62%), admitted after a fall. 105 patients (62%) underwent one to one rehabilitation consisting of falls education and individual exercise plans, 64 patients (38%) underwent gym-based rehabilitation, where strengthening and balance exercises were conducted in groups to improve overall function and increase confidence in functional ability. No adverse safety incidents were reported and a high level of satisfaction after interaction with the EP was conveyed. Initial focus was on patient feedback and satisfaction to ensure input o+- f an EP was well received and accepted.

Conclusion
Intervention by a non-clinical EP to improve the PA of hospitalised older people is acceptable, feasible, appears to be safe and is associated with increased patient satisfaction. By capitalising on SF expertise, we provided a clinical standard on exercise for older adults and built a strong relationship between our workforce to bridge community and acute services. Next steps are to increase the scope of interventions, evaluate quality of life pre and post hospitalisation, capture trust level metrics including length of stay, readmission rates and discharge destination to further evaluate the impact on service users.