bluuebunny/crossref_metadata_2025_split huggingface dataset:
107 Communication deficits at transitions of care
Authors: Walsh A , Costello R , Larkin J , O’Connor M 
Published: September 2023

Abstract

Background
Successful rehab relies on accurate and timely communication between the referring and receiving hospital. As it currently stands patients’ case notes are not permitted to accompany patients on transfer to our off- site rehabilitation centre. Transfer documentation is depended upon to provide accurate medical information. Delays in obtaining this documentation and omitted information and or information deficits exposes patients to considerable clinical risk. This audit examined the adequacy and accuracy of documentation provided at transition of care.

Methods
The discharge documents of patients transferred from an acute hospital to an off-site rehabilitation unit over 3 months were analysed. Demographic information, presenting complaint, history of presenting complaint, past medical history, course of hospital stay and follow up plans were recorded.

Results
Transfer documentation of 27 consecutive patients were analysed; median age 78 years (range 71–95 years);52% female. One of the 27 letters contained all relevant medical information. Demographic data was correct in 26/27 the remainder had no patient identifier recorded. Presenting complaint was recorded in all letters but the history of same was included in just 44%. 48% of letters had incomplete medical history. Conditions omitted which may require adaptation to rehab programme included joint replacements (n = 4), dementia (n = 3), visual impairment (n = 3) and respiratory conditions (n = 3). 67% of patients underwent acute orthopaedic trauma surgery, 50% had no surgery date recorded and 83% had no weight bearing status recorded. A follow up plan was documented in 18% of patients.

Conclusion
Transitions of care pose significant risk to safe continuity of patient care. Our study shows transfer documentation was substandard and deficient in medical information that is necessary to formulate a safe and appropriate rehabilitation plan. Furthermore it exposes the patient to unnecessary duplication of diagnostics. Contemporaneous access to patients case files during their rehab admission would reduce exposure to potential harm and expedite formulation of realistic shared goal setting in the rehab setting.
108 Accuracy of medication prescriptions at transitions of care: an avoidable patient risk
Authors: Walsh A , Costello R , McKeag A , O'Connor M 
Published: September 2023

Abstract

Background
Transitions of care are well recognised as exposing patients to potential risk and harm. Patients in our rehabilitation centre transfer from a nearby acute hospital. Case-notes are not permitted to accompany patients off-site. The aim of this study was to record and quantify medication errors and omissions occurring at care transitions.

Methods
The transfer documents and prescription of consecutive admissions over a three month period were analysed. Allergy status, accuracy of medication lists including drug omissions, duplication, dosing errors; and inappropriate prescribing were recorded. Medication reconciliation by our clinical pharmacist took place within 24–72 hours of patients transfer to our rehabilitation unit.

Results
27 patients were included, median age 78 years (range 71–95 years). 52% female. 59% of transfer medications lists were inaccurate. No allergy status was recorded in 22% of cases. Discrepancies between letters, prescription and Kardex occurred in 55% of patients. A total of 38 prescribing errors were noted in 16 patients with 10 patients having ≥1 error, 3 patients with ≥3 errors and 3 with ≥5 errors. The most common errors related to: analgesia (n = 8), bone protection and vitamins (n = 6), antiplatelet and anticoagulants (n = 5), anti-hypertensives (n = 4), sedatives (n = 3). 2 patients transferred to rehab with prosthetic joint infection had their antimicrobials omitted from transfer documentation.

Conclusion
Medication errors, omissions and inappropriate prescribing are common on discharge from acute care. in some cases patients had been on incorrect doses of medications for the duration of their acute stay. This reiterates the importance of clinical pharmacy as an integral part of comprehensive geriatric assessment and where it is absent the risk of avoidable patient harm is considerable. It took considerable time and effort from medical and pharmacy staff on the rehabilitation unit to reconcile patients medications in a timely manner to reduce serious harm.
110 Identification of Urinary Incontinence through Comprehensive Geriatric Assessment among an integrated care programme of older persons population
Authors: Morris E , Dolphin H , Morrison L , Keating J , Kennelly S P 
Published: September 2023

Abstract

Background
Urinary incontinence (UI) is an under-reported and treatable condition, associated with reduced quality of life. The Integrated Care programme of Older Persons (ICPOP) supports people with complex care needs in their home. There is no available research on the rate of UI among the ICPOP population. This study aimed to assess UI in this group.

Methods
A convenience sample of 100 patient records selected randomly from an ICPOP serving approximately 30,000 people from 2017 to present were retrospectively reviewed; including patients charts, Comprehensive Geriatric Assessments (CGAs) and outpatient letters. As part of the CGA each person was assessed for UI on domiciliary visit. Irish geriatric medicine trainees were surveyed to assess their self-reported confidence assessing and treating UI.

Results
Of the 100 patients CGAs reviewed, 62% were female. 11% had UI reported on their referral to ICPOP. 56% reported UI during their CGA. Only 18% of those with UI had UI generated on to their problem list. Of those patients with UI, polypharmacy (≥5 medications) was noted in 89%. 77% of those with UI were on a medication associated with worsening UI, while only 18% of those with UI were on a treating medication for UI. 25% had their UI assessed at clinic, including 7% who were referred onwards to urology for management of their UI. 80% of geriatric medicine trainees said that they did not feel confident managing UI and 100% said they would like to receive further teaching on UI.

Conclusion
CGA is an excellent method for identifying UI. This data suggests that UI is more prevalent among the ICPOP as compared with an inpatient population and the general population in the same age group. Further specialist teaching is needed to improve trainee confidence in this area.
116 Shared Decision Making (SDM): implementation and evaluation in our perioperative care of older people undergoing (POPS) service
Authors: Hobbs H , Forsyth L , Litto E , McCluskey-Mayes B , Godage P , Bell T , Meilak C 
Published: September 2023

Abstract

Background
Shared decision making (SDM) is a routine part of our POPS service, where older, complex patients are seen. Up to 16% of patients are estimated to regret having had surgery. We wanted to see what impact SDM had on our patient’s surgical choices and decision regret after surgery.

Methods
Retrospective audit of all POPS outpatient letters between October 2019–February 2023: Age, Rockwood frailty score, operation type and outcome of SDM was recorded. Decision regret survey sent out 6 months post-surgery between August 22–April 23.

Results
SDM outcome data: (1) Threshold Abdominal Aortic Aneurysms (AAA): 262 patients, mean age 79, median Rockwood score 3–15% chose not to proceed with surgery. 16% not fit for proposed surgery; (2) Sub-threshold AAA: 78 patients, mean age 78, median Rockwood score 4–12% chose to stop surveillance, 23% not fit for aortic intervention; (3) Peripheral arterial disease: 127 patients, mean age 76, median Rockwood score 4–6% chose not to proceed with surgery and 17% not fit for proposed surgery; (5) Orthopaedic: 111 patients, mean age 83, median Rockwood frailty score 4–13% chose not to proceed with surgery, 5% not fit for proposed surgery. Decision regret outcome data: 87 questionnaires sent with a 69% response rate. 30% of patients who responded had some sort of complication. 23% had 30-day post discharge unplanned readmission. 3/60 (5%) of responders regretted having surgery. 52% of non-responders had some sort of complication and 41% had an unplanned readmission. One patient died.

Conclusion
Multidisciplinary team working helps us to inform patients in preparation for SDM. Asymptomatic versus symptomatic disease may influence decision making when based conversations about quality of life. Exploring decision regret helps to inform us how well we are supporting our patients with their surgical decisions.
126 Rhythmic connections: a pilot interdisciplinary music therapy group programme for people with Parkinson’s in a day hospital
Authors: Cassidy S , Armstrong E , Fox E , Farrell E , Gusha N , Carey G 
Published: September 2023

Abstract

Background
Rhythmic Connections is a music therapy-based (MT) interdisciplinary programme including MT, physiotherapy, occupational therapy and speech and language therapy. The aim of the group is to use evidence-based MT techniques to support participants’ physical, psychosocial and communication goals. There is a growing body of research that supports MT as part of an IDT to support people with Parkinson’s (PwP). However, there is limited research on specific interdisciplinary collaboration in this area.

Methods
This was an 8-week programme with 8 participants. Outcome measures assessing mobility, communication, mood and quality of life were used. Musical preferences were elicited and used to target specific goals. A selection of music was recorded for use between sessions at home. A typical session comprised: Breath support; sustained phonation of varying pitch; balancing tasks using Patterned Sensory Enhancement; Sit to stand; Rhythmic Auditory Stimulation for gait training; Singing to target volume, articulation and intonation.

Results
The majority of participants maintained or improved across all physiotherapy outcome measures. In relation to both mood and quality of life, results varied among participants, with a majority improving or remaining the same. Volume of phonation was either retained or improved for all participants. Of three participants who had impaired intelligibility pre-intervention, two improved and one maintained.

Conclusion
Participants’ feedback suggested that an opportunity to discuss the challenges they experience as PwP could be explored. Future research could investigate the effects of increased intensity e.g. twice weekly. The provision of an exercise log to motivate and monitor intensity could be considered.
129 Can we improve the patient experience for frail, older persons admitted with delirium?
Authors: O'Looney L , Leonard R , Lennon M , Treacy-McCarthy K , Hannon S , Heery H , Hannon N 
Published: September 2023

Abstract

Background
Delirium is a common feature in admission of older adults to inpatient wards. The diagnosis of delirium is often over-looked by healthcare professionals. This leads to lack of early intervention; associated with negative outcomes including prolonged Length of Stay (LoS), avoidable complications, and use of psychotropic medications. We assessed whether a Quality Improvement Program (QIP) should be implemented for frail older patients focused on identification and intervention of delirium.

Methods
The pre-intervention retrospective audit included patients aged 75 or older, assessed by the Frailty at the Front Door team in a four-month period (2022). All patients had 4AT score of 4 or greater, indicating a delirium syndrome. Data was collected on discharge destination, Clinical Frailty Score (CFS), LoS, and number of bed-moves. A selection of patients had in-depth medical record reviews to identify whether delirium was documented, and what interventions occurred, including pharmacological.

Results
Data was collected on 40 patients, age range 77–97 years, median age 86 years. 57.5% were aged 85 or older (23/40). Median CFS was 5, Median 4AT score was 5. 30% had a 4AT score ≥ 7 (12/40). 57.6% (19/33) were discharged home to their usual residence, 30.3%(10) went to inpatient ‘respite’. 4 patients were not admitted. Longest LOS was 42 days, average LOS 8 days. One patient experienced 13 bed moves during their inpatient stay (average = 8). 19 patients had in-depth chart review: 2/19 had appropriate documentation of delirium in the ED, 6/19 as an inpatient. 1 patient had non-pharmacological interventions recommended. 2 patients were discharged on a new psychotropic medication.

Conclusion
In an older, frail population presenting to ED, delirium is under-recognised despite routine use of 4AT score. Non-pharmacological interventions are under-utilised. Patients experience prolonged inpatient stays and frequent bed moves, and are likely to be discharged to a different inpatient unit for ‘respite’. A QIP will be developed aiming to improve patient experiences.
141 Perspectives of key stakeholders on an adaptive physical activity mHealth intervention in the prevention of secondary stroke: a qualitative study
Authors: Cardy N , Hunter A , Carter D , O'Donoghue M , Carvalho M , Carr E , Walsh J , Bernhardt J , Fitxsimons C , Rishardson I , Salsberg J , Glynn L , Walsh C , O'Driscoll E , Boland P , Cunningham N , Forbes J , Galvin R , Hayes S 
Published: September 2023

Abstract

Background
Engaging in regular Physical Activity (PA) is associated with lower mortality post-stroke, and PA reduces the chance of recurrent stroke. Despite recent guidelines to optimise PA post-stroke, people with stroke are known to be less active than their age-matched counterparts. Given the heterogenous nature of stroke, PA interventions, which are adaptive to individual performance, are recommended. Empirical data is lacking on the design and delivery of adaptive PA interventions post-stroke. Suggested strategies recommend the use of mobile health (mHealth) interventions. The aim of this study is to explore the perspectives of key stakeholders on the design and development of an adaptive mHealth PA intervention post-stroke.

Methods
People with stroke, healthcare professionals and carers participated in semi-structured one-to-one or focus group interviews. A reflexive thematic analysis was undertaken on transcribed interviews and key themes and sub-themes were developed.

Results
Twenty-eight interviews were conducted across stakeholder groups including people with stroke (n = 12, mean age 55 years), healthcare professionals (n = 10) and carers (n = 6, mean age 67 years). Three main themes relevant to the design and development of the intervention were identified: (1) Key features of a mHealth PA intervention, (2) Pragmatic intervention delivery, (3) Challenges to development and use.

Conclusion
There was widespread agreement across stakeholder groups that an adaptive mHealth PA intervention post-stroke would be beneficial following discharge from acute care. Our data supports the development of individually adapted programs, to increase PA post-stroke. These findings present new perspectives across stakeholder groups on the design and delivery of an adaptive, mHealth PA post-stroke. Taken together with existing quantitative evidence, these findings will inform the development of a feasibility trial, examining patient and process outcomes, to increase PA levels post-stroke.
143 Nursing home care in Ireland and the built environment: key emerging issues and insights
Authors: O'Donoghue J , Xidous D , Grey T , O’Neill D 
Published: September 2023

Abstract

Background
Nursing homes for older people were badly affected by COVID-19 resulting in serious impacts on residents, staff, and family members. Like other airborne infectious diseases, COVID-19 has implications for spatial practices and the built environment. Although limited research has identified certain built environment issues which impact Infection Control (IC), these issues also have a negative impact on resident quality of life. Based on the paradigm shift created by COVID-19, we explored aspects of the built environment and emerging issues within nursing homes in Ireland with key representatives/experts from different aspects of nursing home provision, policy, and IC.

Methods
20 interviews were conducted with various experts, followed by a thematic analysis to analyse, and generate key themes arising from the interviews.

Results
Some of the key emerging issues from the interviews included designing for infection control and future pandemic resilience, climate change and its impacts on older people, innovative care models, and nursing home integration with the community.

Conclusion
This research demonstrates the growing awareness of the built environment as a critical partner in the nursing home health and social care model and illustrates the need for a holistic design approach across all key spatial scales to support the health/wellbeing of older people in nursing homes.
152 Case study: the use of Talking Mats to facilitate assisted decision making in hospital settings with older adults
Authors: McCusker C 
Published: September 2023

Abstract

Background
Talking Mats is a picture based standardised tool to support person-centred decision making for those with impaired communication (or cognition), which is a useful communication tool for Speech & Language Therapists (SLTs). The tool ensures our client’s voice is heard and that they are central to the decision making process. With the newly implemented Assisted Decision Making Capacity Act 2015 (ADMCA) in the forefront of our minds, we must consider our client’s will and preference thoroughly with facilitated discussions, to be fully compliant with this legislative framework, and always ensuring our client’s wishes/requests are central in the decision-making process. In this case example, Talking Mats were used with an 85 year old lady after her second stroke. After a primary stroke (2019), she presented with a mild receptive and moderate expressive dysphasia, impeded by Apraxia Of Speech. She previously communicated with a communication book, with written words. A second stroke (2023), resulted in a moderate–severe receptive and expressive dysphasia.

Methods
Discussions involved a ‘Talking Mat’ with pictures placed on it and the ‘Topic’ cue card. Along the top of the Talking Mat, a standard scale of ‘Yes’, ‘Maybe/unsure’ and ‘No’ icons. Picture cards have written words to assist comprehension. Talking Mats was used in therapy for communicating wishes and problem-solving around discharge planning. The scales used were ‘Managing’ to ‘Not Managing’ or ‘Coping with’/‘Not Coping with’.

Results
The qualitative data collated from the client and her family was very powerful, in helping the client make her wishes known for home, spontaneously she articulated “But not on my own!.

Conclusion
Talking Mats help people with communication difficulties have a greater understanding about the topic and ensures they are ‘directly involved in the process, is more in control, and can consider the options in his/her own time’.
155 Review of the physiotherapy needs of hip fracture patients post discharge from offsite rehabilitation
Authors: McDaid E , Fenton L , Gilheany Á 
Published: September 2023

Abstract

Background
Post-hip fracture in Ireland, 25% of patients transfer to offsite rehabilitation. However, little is known about their ongoing physiotherapy needs at the point of discharge from offsite rehabilitation.

Methods
A retrospective audit of hip fracture patients admitted during 2022 who discharged home was completed. Measures collected included pre fracture mobility using New Mobility Score (NMS), rate of recovery at discharge using remeasured NMS, rehabilitation Length of Stay (LoS) and onward physiotherapy referral. This data was analysed using Microsoft Excel and descriptive statistics.

Results
Of 120 hip fracture patients admitted in 2022 who discharged home, there was complete data available for 116. No patient recovered their pre fracture mobility at point of discharge. The mean percentage recovery to pre fracture NMS at discharge was 55% and 84% for those with higher (NMS 7–9) and low (NMS 1–6) pre fracture mobility respectively. Over half (64%, n = 74) were referred for further physiotherapy on discharge from rehabilitation. Most onward referrals were for the rehabilitation day hospital (47%, n = 35), followed by community physiotherapy (28%, n = 21) with the remainder being referred to OPD and private physiotherapy. Those with higher pre fracture mobility (NMS 7–9) were more likely to be referred for further physiotherapy with 69% of this group being referred onwards compared to 36% of lower pre fracture mobility group (NMS 1–6). There were geographical trends reflecting service access with increased community physiotherapy referrals made in areas outside the catchment of the rehabilitation day hospital. Patients referred to community physiotherapy had a shorter mean rehabilitation LoS (35 days) compared to those referred to the rehabilitation Day Hospital (52 days).

Conclusion
Within this sample of hip fracture patients who went to off-site rehabilitation, those with higher pre-fracture mobility had a reduced rate of recovery to their pre-fracture mobility and were more likely to be referred for physiotherapy post discharge from rehabilitation.
187 Prospective study of patients admitted to a model 2 hospital
Authors: Kelly L , Watts M 
Published: September 2023

Abstract

Background
Model 2 hospitals provide in-patient and out-patient care for differentiated, low-risk medical patients, who are not likely to require full resuscitation. Smaller hospitals are generally very well regarded by the local population and general practitioners.

Methods
This is a prospective descriptive study. Data were collected from all patients admitted via the Medical Assessment Unit (MAU) or stepped-down from a model 4 hospital for six consecutive weeks. Data points included: route of admission, age, Rockwood Clinical Frailty Scale (CFS) on presentation, length of stay (LOS), long term care/community resident, if delirium was present, known cognitive impairment, number of medications, hospital admissions in the past year and discharge destination.

Results
144 patients were recruited to the study—79 via the MAU, 64 stepped down from a model 4 hospital and 1 via outpatient clinic, 95 of whom had a hospital admission within the previous year. The average age of patients was 72 years with a mean CFS of 4. 38% of patients were felt to be delirious on presentation to hospital, with 14% having a formal diagnosis of cognitive impairment prior to admission. Over 80% of patients were prescribed 5 or more medications in the community. Average overall LOS at the module 2 hospital was 9 days; 8 days for patients admitted via the MAU and 12 days for those stepped down from a model 4 hospital. The mean LOS at module 4 hospital prior to transfer was 6 days. 92% were living in the community prior to admission, 82% of which returned home.

Conclusion
Model 2 hospitals are a vital resource, particularly catering for the geriatric population. Patients are often multimorbid and admissions are often complicated with polypharmacy, delirium and discharge planning. Further exploration is required to assess how best to appropriately staff and resource them.