bluuebunny/crossref_metadata_2025_split huggingface dataset:
1287 THE VALUE OF A MULTIDISCIPLINARY TEAM (MDT) IN MANAGING PATIENTS WITH COMPLEX OR UNEXPLAINED SYNCOPE
Authors: McCall R , Anderton L , Mitchell L 
Published: January 2023

Abstract

Introduction
Syncope is a common clinical problem with a lifetime prevalence of 20%.1 Syncope shares clinical features with other disorders including seizures, metabolic disturbances and sleep disorders.2 The assessment and management of syncope can be challenging. The syncope service at the QEUH is run by geriatricians and cardiologists with an interest in syncope. Although MDTs are recognised key components in contemporary patient care in areas such as heart failure and cancer management, there is no guidance on MDT working in syncope management.3/4 In November 2017, a syncope MDT was introduced at the QEUH involving cardiologists, geriatricians, a neurologist and cardiac physiologists. This in-person MDT occurs monthly with outcomes recorded on electronic medical records in addition to a database. The aim of this review was to understand the potential impact of the MDT on diagnostic yield and time to further investigation or management.

Method
A retrospective case note analysis was performed for patients reviewed at the Syncope MDT between November 2017 and December 2021.

Results
103 patients were discussed with an average age of 64 years. The main reason for referral was cardiology specialist advice (65%), neurology specialist advice (19.4%) and complex case review (13.6%). After MDT discussion, the percentage of patients with unexplained TLoC reduced from 26.2% to 14.6% without requirement for additional investigations. 8.7% of patients were started on anti-epileptic medication prior to outpatient neurology review after a diagnosis of seizure disorder was established and 23.1% of patients were streamlined for pacemaker or ILR insertion.

Conclusion
Introduction of a syncope MDT reduces unexplained syncope rates in complex patients, streamlines investigations, reduces the need for multi-speciality outpatient reviews and allows earlier introduction of anti-epileptic medication for those with a new seizure disorder. These benefits improve the patient experience by reducing time to diagnosis and treatment.
1290 CAN P1NP LEVELS INFLUENCE MANAGEMENT PLANNING FOR PATIENTS WITH A FRAGILITY HIP FRACTURE RECEIVING ANTI-RESORPTIVE MEDICATIONS?
Authors: Kraidi M , Wilkinson I , Bandyopadhay S , Griffiths S 
Published: January 2023

Abstract

Introduction
Procollagen-N-terminal-peptide (P1NP) is a bone formation marker. Bisphosphonates lead to a reduction in P1NP levels and levels are significantly elevated shortly after fracture. In older patients taking bisphosphonates who have had a further osteoporotic fracture there is a lack of evidence to guide ongoing osteoporotic management.

Objectives
To assess if measuring P1NP in patients receiving Bisphosphonates treatment who develop neck of femur fractures helps guide further management in regards to long term bone protection treatment.

Method
Retrospective descriptive cohort study of P1NP levels for the patients who presented with NOF# (&gt;60yrs) and who were taking anti-resorptive medications. Cases were discussed in our complex bone health MDM and patient specific plans made accordingly.

Results
60 patients were identified between March 2017 and Sept 2021 had P1NP tested (2.6 % of the 2,303 total fractures in this time). Mean age 83 years (F:M – 54:6 / # type - IC:EC – 34:26). Overall: 17 (28%) patients had significantly elevated PINP with identifiable reasons. 39 (65%) patients had supressed P1NP levels (&lt; 35mcg/L) and 5(7 %) between 36-39 mcg/L. Of those with supressed P1NP: Patients taking treatment &gt;5 years (n=9) – Treatment stopped for 6 patients, 2 changed treatment following DXA and 1 continued. On treatment 3-5 years (n=8) – 5 continued with treatment, 1 had further ix and 2 treatments changed On treatment 1-3 years (n=17) – 14 continued treatment, 2 treatments stopped, 1 treatment changed On treatment &lt;1 year (n=16) – all continued the same treatment

Conclusion
The measurement of P1NP has been helpful in making patient centred decisions in this cohort. It has added to the detailed discussions in the hip fracture bone health MDM and for 23% of patients with supressed bone turnover contributed to a change in management. Most changes occurred in those patients taking treatment for more than 5 years where the evidence of bone turnover suppression gives confidence to stop or change treatment.
1327 PROACTIVE COMPREHENSIVE GERIATRIC ASSESSMENT FOR CARE HOME RESIDENTS LIVING WITH FRAILTY
Authors: Robinson A , Chaplin A , Farnsworth M , Sin Chan C 
Published: January 2023

Abstract

Introduction
Frailty is a long-term condition with potentially significant associated healthcare costs and resource usage. The gold standard evidence-based intervention is a comprehensive geriatric assessment. The NHS Long Term Plan highlights the importance of ageing well and developing proactive services in the community. Care home residents often have unmet health and social care needs, and are frequently frail.

Methods
59 patients with severe or very severe frailty (Rockwood clinical frailty score 7 or 8) across three care homes with both residential and nursing provision were reviewed in person. They were then discussed in an MDT comprised of geriatricians, GPs, community matrons, district nurses, community therapists and care home staff in order to complete a virtual CGA resulting in a personalised care plan.

Results
In the 8 weeks after MDT, compared to the 8 weeks before, there was a 49% reduction in GP contacts (28 vs 55) and a 17% reduction in ED attendances (5 vs 6). There was a 133% increase in proactive referrals (7 vs 3) and 20 advanced care plans were completed. 74 medications were reduced or stopped whilst 4 medications were started, with a cost saving of £812.58 over the 8 week follow up.

Conclusions
Despite a small sample size and a short follow up period, these results suggest that intervention with a proactive CGA provides benefits to frail care home residents, particularly with regards to reductions in polypharmacy and improved access to advanced care planning. These results also suggest potential benefits to the wider system, with reductions in GP contacts and unplanned hospital attendance. We suggest that in future a CGA should be completed for each new resident to a care home as the basis of a personalised care plan.
1335 POSTURAL HYPOTENSION QUALITY IMPROVEMENT PROJECT - HOW GOOD WE ARE IN MEASURING IT?
Authors: Eng C , Cernovschi N , Aung Htin , Jozefczak J 
Published: January 2023

Abstract

Introduction
A large proportion of Morriston Hospital’s acute medical take consists of elderly patients admitted with falls. Postural hypotension is a cause of syncope and fall which contributes to morbidity, disability and death in cases of injury in the frail and elderly population1. Hence, diagnosing and treating postural hypotension is crucial. It is important that the measurement of lying-standing blood pressure (LSBP) is consistent to ensure reliability of results as this would affect patients’ management. The aim of this project is to assess how postural hypotension is diagnosed in various clinical areas and assess the quality of detection.

Methods
We designed a survey to identify baseline variation in method and accuracy in measuring postural hypotension and compared it against National Audit in-patient Falls RCP “Falls and fragility Fracture Audit Programme”1. The survey was distributed across acute and general clinical areas involving staff nurses, healthcare assistants and junior doctors. We collected and analysed the data, implemented outcomes and re-conducted the second PDSA. Grand Round presentation and worked-based tutorial sessions based on the above was our intervention.

Results
57 staff members (acute medical, surgical wards and emergency department) participated. PDSA2 showed improvement of &gt;25% of participants allowing patients to rest before initial BP measurement compared to PDSA1. There is an improvement of approximately 7% in repositioning the patient. 47% measured standing BP between 1-3mins at PDSA1 and this has doubled in PDSA2. Conclusions
This study showed the importance in ensuring consistency in measuring LSBP. There was significant variation in timing and measurements which have impacted the results and interpretation of postural hypotension. The education sessions had positive impact and is also a sustainable practice.

Reference
1. Falls Prevention in Hospital, 2022.
1360 REVIEW OF OUTCOMES OF PATIENTS ADMITTED TO AN ENHANCED ASSESSMENT BED AT AN INTERMEDIATE CARE UNIT
Authors: Mason C , Edwards S , Packer S , Mahmood K , Gupta A 
Published: January 2023

Abstract

Introduction
The Norman Power Centre (NPC) is an Intermediate Care Unit, in Birmingham, UK, providing enhanced assessment beds (EAB) where patients undergo functional assessment after an acute admission. There is little published data regarding the outcomes for patients admitted to EAB, so we set out to analyse outcomes in our unit.

Method
Data was collected from 50 patients who were discharged from EAB between September 2021 and March 2022.

Results
The mean length of stay was 36 days, median was 29 days. Of the 50 patients: 4 went home with no services, 9 went home with Early Intervention Community Team (EICT) support, 5 went home with package of care (not EICT), 13 went to new residential home placements, 6 went to new nursing home placements, 11 were re-admitted to hospital, 1 died and 1 received palliative care. 28 patients went to the destination that was originally intended on admission, 9 went to a less restrictive option and 12 required a higher dependency destination (predominantly re-admission to hospital.) The change in Elderly Mobility Scale from admission to discharge ranged from -1 to +15. Mode and median were both 0 and mean change was +2. 49 patients had Barthel scores on admission and discharge. Change in score ranged between -1 and +9. Mode and median change was 0, and mean was +1.7.

Conclusions
This data shows positive outcomes in terms of discharging most patients to their intended, or better, destinations. It also gives us an objective measure of the change in functional status that patients are achieving during their stay. There is a high rate of hospital re-admissions, indicating the unstable nature of the health of frail people. We are now ready to move onto a PDSA cycle to see if we can improve outcomes for our patients.
1172 APPLYING THE NATIONAL STANDARDS OF PERIOPERATIVE CARE OF OLDER PEOPLE UNDERGOING EMERGENCY LAPAROTOMY (NELA)
Authors: Robinson P 
Published: January 2023

Abstract

Introduction
There are well documented in-equalities for outcomes for surgical intervention associated with Age and Frailty including emergency laparotomy. NELA data has shown over half of such patients are over 65 years old about one fifth are over 80. These patients having significantly higher mortality, longer hospital stays and it has also shown frailty to be an independent marker of poor outcomes. Through application of key standards these outcomes have improved however input from “consultant geriatrician-led MDT” remains stubbornly low nationally.

Aims
To improve local Trust performance in meeting the NELA standard: “Peri-operative assessment by a member of the Geriatrician-Led MDT for frail (CFS 5+) patients 65 or older” to &gt;80% (Green: ≥80%, Amber: 50 – 79% Red: &lt;50%) of estimated 100 patients per year.

Methods
1. Proactive case finding with general surgical teams; 2. Engagement with Emergency Surgical Committee and NELA leads; 3. Improved our own electronic referral system; 4. Assist in development of electronic booking system with emergency laparotomy cases

Results
We showed a significant improved in meeting the NELA standard from the red zone (Mean: 33% range 5% to 35%) into the amber with a of mean 60% (quartile range 52% to 78%) but still remains below our target with significant quarterly variation seen. All referrals and assessment remain post-intervention.
Limitations in measures:

Conclusions
Following a number of change ideas and despite challenging COVID related staffing issues we showed that a combination of key stakeholder engagement, proactive case-finding and improved referral processes we have improved Geriatrician input in frail patients undergoing emergency laparotomy. We suspect due to the non-systematic assessment of frailty that we may be missing some patients and or seeing late in care pathway.
1210 PROVISION OF EYE CARE SERVICES AND INTERVENTIONS IN CARE HOMES - A NARRATIVE SYNTHESIS REVIEW
Authors: Ma N , Low S , Hasan S , Banna S , Patel S , Kalsi T 
Published: January 2023

Abstract

Introduction
The prevalence of eye disease and visual impairment in care home residents is disproportionately higher compared to the general population. Access to eye care services and treatment can be variable for this vulnerable population.

Objective
This narrative synthesis reviews the available evidence of services and interventions for delivering eye care to care home residents. The key review questions:

Methods
Literature search of EMBASE/MEDLINE for original papers published since 1995. Two reviewers independently reviewed abstracts/papers. Data was extracted and evaluated using narrative synthesis.

Results
13 original papers met the inclusion criteria. On-site optometrist-led services improved diagnosis and management of eye conditions, with one study showing 53% of residents benefited from direct ophthalmology intervention. Provision of interventions such as cataract surgery, refractive error correction and low vision rehabilitation improved visual acuity and vision-related quality of life but did not improve cognitive or physical function, depression or health-related quality of life. There was little UK-based literature to inform eye service design or interventions to improve outcomes.

Conclusion
Care home-based eye assessments improve the management of eye conditions. Interventions improve visual acuity and vision-related quality of life. Further research and/or clinical service scoping is needed to better understand current UK services, access difficulties or examples of good practice as well as to identify and test cost-effective service models for this vulnerable group.
1211 FRAIL TRAUMA PATHWAY: ENCOUNTERING STUMBLING BLOCKS
Authors: Halevy C , Stephen F , Lochrie N , Jennings C 
Published: January 2023

Abstract

Introduction
The Trauma Audit and Research Network report “Major Trauma in Older People” highlighted the need to recognise falls in older patients as a mechanism leading to potentially life-threatening injuries. Reasons behind falls can be equally serious and must be addressed concurrently. A Frail Trauma Pathway was introduced in the Emergency Department (ED) of a Major Trauma Centre (MTC) and subsequent audit revealed it was underutilised. We relaunched the Frail Trauma Pathway incorporating a checklist with the aim of improving patient care.

Method
Retrospective data was collected over one week, including patients over 65 years with a Clinical Frailty Score ≥5, a low velocity trauma and multiple injuries or isolated head injury. We then updated the Frail Trauma Pathway incorporating a checklist, re-distributed it throughout the ED, sent staff email reminders and held teaching sessions. An educational “Advent Calendar” was circulated daily in December. Following this we repeated data collection.

Results
20 patients pre and 18 post-intervention fitted inclusion criteria. There was a reduction in admission rates, improvement in ED senior doctor review for primary survey, increase in timely administration of Parkinson’s disease medication and venous thromboembolism assessment. However, there was a decline in other parameters measured. Due to the small patient cohort, it is difficult to assess if changes in results post-intervention are statistically significant.

Conclusion
Several aspects of the frailty pathway showed improvement, notably admission reduction. This QIP demonstrates the difficulties of instigating change in an MTC, where numerous pathways result in ‘information overload’ and staff numbers are large and constantly changing. By focusing on the frail trauma checklist and incorporating it into our electronic records system we hope to improve compliance with the pathway. Further research on a national level is required to determine how to best care for this expanding cohort of patients.
1343 ADVANCE CARE PLANS (ACP) IN SECONDARY CARE: WHAT ARE THE PATIENT OUTCOMES FOLLOWING DISCHARGE FROM HOSPITAL WITH AN ACP?
Authors: Hay W , Yard J , O'Donnell J 
Published: January 2023

Abstract

Introduction
Treatment escalation plans are discussed in hospital but not always communicated to community care on discharge, leading to avoidable admissions to hospital and hospital deaths which may be not what the patient wants. The project aimed to review what happened to patients discharged from hospital with an ACP over a 12-month period.

Method
Older person service (OPS) inpatients were identified for ACP discussions, using Clinical frailty score, presence of life limiting conditions, co-morbidities, significant decline. Over a 12-month period 155 ACP's were completed using the ACP document on the Trust electronic record (EPR), including the level of appropriate care and preference for location of on-going care. On discharge copies of the ACP were sent with the patient, to their GP and the ambulance service. EPR was used to review patients up to 12 months post discharge.

Results
Of patients with an ACP; the wish of all patients was to remain out of hospital and be cared for in the community; 63% were discharged to care home setting; 19% were readmitted as inpatients (43.7% Trust OPS/no ACP readmissions); 8% of patients died before discharge; 92% of patients who died after discharged, died out of hospital (47.5% Trust OPS/no ACP deaths); 25% were still alive at 12 months. The process of completing the ACP and communicating the ACP was found to be long and not user friendly with multiple steps and needed refining.

Conclusion
ACP's offer support to facilitate patient's wishes. The use of ACP's in secondary care benefits patients on discharge, it reduces readmissions and in-hospital deaths. The current ACP document is lengthy and requires simplifying. This has led to a work group to redevelop the ACP into a more user friendly/shareable document, which will encourage on-going use of ACP's and can be adopted throughout the Trust.
1151 IMPROVING THE MEASUREMENT OF POSTURAL BLOOD PRESSURE WITH AD-HOC MOBILE TEACHING SESSIONS FOR NURSES AND HEALTHCARE ASSISTANTS
Authors: Jones T N , Wilson P , Hoy E , Pherwani S , Meng J , Jethwa N 
Published: January 2023

Abstract

Introduction
Falls are a major cause of morbidity and mortality in patients over 65. Unrecognised postural hypotension is a significant and treatable contributor. Training nurses and health-care assistants (HCAs) in correct measurement technique can be challenging, as these groups are rarely able to fully attend single sessions due to urgent clinical commitments, night duties and staff-shortages. We aimed to improve the frequency and quality of lying-standing blood pressure (LSBP) measurement in a Geriatric inpatient cohort.

Methods
Three PDSA cycles were performed over a 10-month period on a single Care of the Elderly ward, including an initial audit in March 2021. The outcome measures were:
1. the percentage of non-bedbound patients having LSBP correctly measured (5-min recumbent, 1 and 3-min standing readings), assessed by chart review and
2. the understanding and confidence of measurers in correct technique, as assessed by a questionnaire.
The intervention was developed into three separate days of ad-hoc mobile teaching sessions to allow reinforcement of knowledge. Trainers moved from bay-to-bay delivering a 5-minute pre-prepared presentation/demonstration on the indications and correct technique of LSBP measurement. This was repeated throughout each day until all measurers had participated.

Results
On initial assessment, only 21% (6/28) of non-bedbound patients had LSBP correctly measured. This improved to 44% (8/18) by July and 62% (8/13) by December 2021. When sampled, measurers had sustained improvements from July (n=8) to December (n=7), in terms of self-rated confidence (mean 4.4/5 vs 4.9/5), correct technique (25% vs 100%), interpretation of results (25% vs 43%) and knowledge of contraindications to measurement (88% vs 100%).

Conclusions
We describe a strategy using ad-hoc mobile teaching sessions to train nurses and HCAs to measure LSBP in a Geriatric inpatient cohort, which resulted in sustained improvements. We believe this technique is readily applicable to other units and areas of practice.
1324 DEVELOPMENT OF A M&M MEETING INTEGRATING THE SITUATIONAL JUDGEMENT REVIEW (SJR) FRAMEWORK IN A GERIATRIC DEPARTMENT
Authors: Palmer-Jones C , Zamfir I , Stoian I 
Published: January 2023

Abstract

Introduction
The National Mortality Case Record Review Programme commissioned in 2016 aimed to improve the learning from deaths process. As part of this aim, several reports were published, which identified barriers in implementing the mortality review process. Mortality and Morbidity (M&M) meetings can be an important mechanism for removing these barriers, and while have been in place for a long time in surgical specialties, are only recently becoming more common in medical specialties. We have developed an innovative M&M meeting in our geriatric department to integrate Mortality case reviews with teaching and QI development.

Methods
We created a standardised mortality data collection proforma, using the (SJR) framework as a template. During the development, feedback was obtained from consultants and juniors. Data was then collected using the proforma by trainees, and all mortality cases were then reviewed with consultant supervision, and specific cases were chosen for their educational benefit or requiring areas of improvement. Cases were then presented at the meeting. At the end of the meetings, an action plan was then created in collaboration with the consultant and juniors in the meeting to create a teaching plan or develop a QI project to help improve service.

Results
From feedback gained, the M&M was well received, and has already helped improve training and delivery of end of life care and recognising the dying patient. There were several difficulties identified during the process such as incomplete medical records, time and lack of engagement from other team members due to work pressures.

Conclusion
Mortality meetings are an essential part of junior doctor training and hospital clinical governance, often times underutilised. They can support quality improvement and professional learning, especially when facilitated by a standardised mortality review process.