bluuebunny/crossref_metadata_2025_split huggingface dataset:
80 A PILOT POPS SERVICE (PERI-OPERATIVE CARE OF THE OLDER PERSON UNDERGOING SURGERY): A PROMISING START
Authors: Magee M , Leung S 
Published: October 2022

Abstract

Background
It is understood that older persons undergoing surgery benefit from Comprehensive Geriatric Assessment (CGA), however these services remain limited in Ireland. Latest guidelines recommend all patients over 65 undergoing surgery should be screened for frailty and receive a CGA if frailty is identified. Our pilot service was to implement this on our acute surgical in-patient ward.

Methods
Baseline data was gathered prior to implementation of our service. Interventions included education, dedicated sessions for geriatrician input on ward, single point of referral and increased signage. Patients identified as living with frailty (Rockwood Clinical Frailty Score (CFS) ≥5) then received CGA. Progress monitored with monthly audit and foundation doctor feedback surveys over a 6-month period.

Results
We have increased the percentage of patients over 65 being screened for frailty from 0% to a peak of 100% over our pilot 6-month period. Foundation doctor surveys showed an improvement in confidence in screening for frailty (19 to 100%) and managing frailty (13 to 80%). They also reported feeling more supported managing these patients (38% to 100%). Focusing on patients with CFS ≥5, we have shown a reduction in length of stay from a mean of 20 days to 11 days, albeit numbers remain small.

Conclusion
By increasing identification of frailty in older patients, we have managed to apply CGA to appropriate patients. Geriatrician input on the surgical ward has also allowed foundation doctors to feel supported and improve confidence in managing patients living with frailty. Furthermore, we have shown a trend towards reduced length of stay. However, our patient numbers remain low and there is a reliance on our team to screen all patients over 65. Our focus moving forward is for the surgical team to screen for frailty allowing us to expand the service to other surgical wards.
82 THE IMPACT OF THE COVID-19 PANDEMIC ON THE ACTIVITY OF A RAPID-ACCESS GERIATRIC DAY HOSPITAL SERVICE
Authors: Moloney K , Byrne T , Mathews S , Foran M , Conroy B , Molamphy A , Murphy N , Dillon A , Doyle K , Cunningham C , Romero-Ortuno R 
Published: October 2022

Abstract

Background
In the 1970s, Jack Flanagan developed the first Geriatric Day Hospital (GDH) in Ireland. Since, the GDH model of care has evolved to accommodate for the growing demands of our ageing population. Before the COVID-19 pandemic, the operational scope of our GDH was extended to allow for the rapid medical and multidisciplinary assessment and follow-up of older patients. During the pandemic, the GDH did not suspend operations and remained open as a COVID-negative ambulatory pathway. We evaluated the activity of this GDH service.

Methods
Retrospective Service Evaluation Approval was granted by our Research & Innovation Office (Reference: 7419). Pseudonymised data corresponding to all GDH attendances between January 2017 and December 2021 were retrieved from the hospital electronic records. Yearly trends in proportions were tested with the Chi-square for trend statistic. Trends in monthly attendances were assessed via Statistical Process Control (SPC) charts with three-sigma limits. Statistical significance was set at p&lt;0.05.

Results
There were 27,278 attendances of patients aged 65 and over to the GDH over the 5-year period (6,362, 5,978, 6,115, 4,306, and 4,517, respectively). Mean age was 82 every year. Of the 7,813 new episodes, yearly proportions referred directly by primary care teams were 10.4%, 29.5%, 38.6%, 24.5%, and 16.3% (p&lt;0.001). SPC charts showed that Apr-May 2020 and Jan-Feb 2021 had significantly lower numbers of review attendances (50-59 and 146-142, respectively, average 324 p/m). However, new appointments did not significantly decline (average 130 p/m). Of the 7,813 new episodes, 2,595 (33.2%) were seen by Physiotherapy, and 1,860 (23.8%) by Occupational Therapy.

Conclusion
Our GDH saw a sustained number of new attendances and demonstrated increased community availability during the unprecedented COVID-19 crisis, especially during the first wave of the pandemic when hospital access was most affected. A rapid access GDH model can facilitate integrated care at times of crisis to promote ageing in place.
95 EXPLORING HIP FRACTURE OUTCOMES IN POST-ACUTE REHABILITATION: A MULTI-SITE AUDIT
Authors: McDaid E , Long S , Curtin C , Burke C , O'Brien K , Cogan L , Ahern E , Mello S , O'Connor M 
Published: October 2022

Abstract

Background
In 2020, 28% of all hip fractures in Ireland were discharged to off-site rehabilitation. The annual Irish Hip Fracture Database (IHFD) report captures patient outcomes at the point of acute discharge however patient outcomes at discharge from offsite rehabilitation are unknown.

Methods
A multi-site retrospective audit was completed examining hip fracture outcomes for patients admitted to four post-acute rehabilitation hospitals during 2021, using IHFD HIPE portals as well as local databases. Descriptive statistics including demographics, pre-fracture mobility as well as outcomes measured including acute length of stay, rehabilitation length of stay, discharge destination and independence with mobility on discharge from rehabilitation. A comparison analysis between sites was completed.

Results
A total of 445 patients were admitted post hip fracture to the four rehabilitation hospitals in 2021. Most were female (69%, n=307), mean age 82.5, 49% lived alone and most (55%) had low pre-fracture mobility as measured by New Mobility Score of 0-6. The mean acute length of stay was 11.8 days and rehabilitation stay 37.6 days. Most (90.2% of complete data, n=333) discharged home, 4.5% (n=17) were transferred to hospital, 3.2% (n=12) were newly admitted to nursing home and 1% (n=4) died. Most (82.2% of complete data, n=256) were independently mobile (CAS 6) at discharge from rehabilitation. There was no significant difference in patient profile between sites however there were significant difference in both acute length of stay (median range 8-13days) as well as rehabilitation length of stay (median range 16-39days).

Conclusion
The findings of this audit provide a new perspective on recovery post hip fracture and insight into longer term hip fracture outcomes. It shows that data collection is feasible in off-site rehabilitation units and should be considered for inclusion in the IHFD. Further work could explore the establishment of standards of care in the post-acute phase of hip fracture rehabilitation.
108 TEIRIPE SA BHAILE TEAM (TSAB): AN EARLY SUPPORTED DISCHARGE SERVICE FOR HIP FRACTURES FROM AN ACUTE HOSPITAL
Authors: Cummiskey AG , Byrne A , Spencer M , Whelan M , Nee R 
Published: October 2022

Abstract

Background
Due to increasing bed strain in hospitals, Early Supported Discharge (ESD) programmes have helped to reduce length of stay for hip fracture patients. Teiripe sa Bhaile Team (TsaB) provides a multi-disciplinary, patient centred approach to care for patients over 60 with hip fractures, in their own home.

Methods
Patient demographics and data has been collected on all TsaB patients to date with consent from the patients. We measured length of intervention with TsaB, patient directed SMART (Specific, measurable, achievable, relevant, time bound) goals, Functional Independence Measure (FIM) sores. We recorded the number of visits required, medical complications and number of readmissions post discharge from our service.

Results
Since formation in 2018 until April 2022, 33 patients have been treated by TsaB. The average age is 78 years old. The average length of stay prior to discharge was 17 days, compared to 54 days for inpatient hip fracture rehabilitation. Patients received an average of 11 MDT visits during the 6 weeks of rehabilitation. The average improvement in FIM score was 42. All set SMART goals, and only 5 (17%) patients did not achieve these goals.
Only 5 (17%) patients were readmitted within 6 months. No patients required initiation of a home care package for discharge, or after our interventions. No patients developed pressure ulcers while on our service, or other medical complications.

Conclusion
Through TsaB, we are able to offer a rehabilitation service to patients based around their own needs in the home. Patients were able to set and achieve their own SMART goals. Patients were moderately frail on admission to our service, but after intervention were able to improve their FIM scores, marking reduced frailty after intervention. We had low readmission rates, and no patients required a change in home care package.
124 AN INTERDISCIPLINARY PREHABILITATION PILOT FOR FRAIL ADULTS UNDERGOING ELECTIVE ANTERIOR RESECTION AND HARTMANN’S REVERSAL SURGERIES IN AN IRISH ACUTE HOSPITAL
Authors: Treanor C , Smith J , McCabe M 
Published: October 2022

Abstract

Background
Frailty affects 21.5% of individuals aged 65 and over in Ireland (TILDA, 2017).Timely interventions can limit or reverse the impacts of frailty. Local HIPE data from 2016-2020 highlighted correlations between increased average Length of Stay (aLOS) and median age (&gt;65 years) for those undergoing elective Anterior Resections and Hartmann’s reversal surgeries. Prehabilitation aims to identify and manage modifiable risk factors that may impact on LOS, as well as optimise patients’ resilience and physiological reserves to reduce postoperative complications. Modifiable factors include pre-operative function, co-morbidities and post-operative delirium. In the Republic of Ireland, surgical interdisciplinary Prehabilitation services exist only in one hospital.

Methods
An interdisciplinary prehabilitation pilot for individuals undergoing elective colorectal surgeries was developed. Patients are referred from surgical clinics to Physiotherapy, Occupational Therapy or Dietitian preoperatively. Interventions include respiratory optimisation, exercise prescription, discharge planning, equipment provision and pre-operative nutritional reviews.

Results
Three elective patients have completed the first phase of the pilot. Two underwent anterior resections and one underwent a Hartmann’s reversal. The LOS for each individual was 4 days respectively, 4 days under the KPIs. Patients received virtual assessment and individualised interventions including an interdisciplinary educational booklet. Interventions included: exercise programmes, nutritional support, discharge planning discussion and equipment as indicated. No post-operative complications were identified and no interim beds or home supports were required. Qualitative feedback surveys were completed by all participants. Subjective feedback from patients has been overwhelmingly positive.

Conclusion
Patients report feeling physically and psychologically better prepared for surgery with better knowledge of post-operative expectations. Patients are more proactive in their postoperative recovery meaning they can return home sooner. This pilot enhances evidence-based ERAS practice, improving the quality and safety of patients journey. Participants also had a 12 day cumulative reduction in aLOS with financial savings of €12000.
157 STAFF MEMBERS’ PERSPECTIVES OF HOW TO INCREASE DEMENTIA-FRIENDLINESS IN AN ACUTE IRISH HOSPITAL SETTING
Authors: Doyle C , Davis A , McNally S 
Published: October 2022

Abstract

Background
Key principles from The Irish National Dementia Strategy promote accessibility and ease of understanding for those with dementia. Those who provide services and care to people with dementia have a key role to play in identifying gaps in existing service provision. Reduced compliance with National dementia guidelines and overall reduced dementia-friendliness were noted in a hospital-wide audit. It is imperative to seek opinions from those providing direct care to dementia patients on how we can improve dementia-friendliness at a service level.

Methods
Random selection was used to distribute staff questionnaires. An open-ended question was used to gather their perceptions on how this hospital can improve its dementia-friendliness at a service level.

Results
Forty-seven suggestions were collated across the hospital. Thematic analysis identified 11 different themes; increased staffing, environmental changes, the introduction of dedicated day rooms, increased signage, and introduction of activity boxes were the most common suggestions (68% of answers). Other suggestions included use of sensory items, increased staff education, orientation boxes and improved communication with patients.

Conclusion
Healthcare workers have an important role in driving and implementing changes in healthcare settings. Collating staff members’ perceptions of improving dementia-friendliness is invaluable given their role in providing services to people with dementia. Implementation of the above-mentioned changes must be explored in order to increase dementia-friendliness, to maintain high-quality service provision, and to ensure compliance with National standards.
189 IMPROVING DEMENTIA CARE THROUGH SELF-EXPERIENCE; CO-DESIGNING A SIMULATION-BASED DEMENTIA EDUCATION TOOLKIT
Authors: Collins R , Forristal K , Hopper L , Riello M , Conotter V , Meyer G , Vugt MD 
Published: October 2022

Abstract

Background
Although specialised dementia education programmes have begun to appear in recent years, they lack consistency. Knowledge gaps persist, which results in a professional workforce who can struggle to anticipate the care needs of people with dementia. Self-experience or simulation practices (e.g., roleplays, virtual reality, sensory tools) are established teaching methods that can provide learning opportunities to experience aspects of illness. These innovative learning approaches can positively impact empathy, understanding, and quality of care; however, they are rarely implemented in specialised care for people with dementia. The Improving demeNtia care Through Self-Experience (INTENSE) project has co-designed a dementia simulation toolkit to educate, equip, and train professionals to better support people with dementia.

Methods
As part of the Erasmus+ INTenSE project, a series of three participatory, online workshops were conducted with people with dementia, informal caregivers, and dementia-care professionals in Ireland, Italy, Germany, and the Netherlands. The first explored the co-design of training scenarios using simulation tools to demonstrate the lived experience of dementia. The second involved the co-design of an online training platform. The third examined the sustainable implementation of INTenSE into practice. All workshops were inductively coded and analysed thematically.

Results
Recommended training scenarios demonstrate daily activities and environments that impact people with dementia using a combination of existing and newly developed simulation tools. Four themes arose from workshop discussions: 1) representation of dementia, 2) daily challenges that impact people with dementia, 3) applying a person-centred approach, and 4) implementing self-experience training. Together these were used to develop facilitation guides to support the implementation of the INTenSE simulation toolkit into practice.

Conclusion
These findings demonstrate the potential of simulating self-experience across a range of everyday scenarios as a means to increase professionals' empathy and understanding of the lived experience of dementia. Recommendations have been developed that support the use of self-experience tools in practice.
193 CONNECTED HEALTH SUSTAINING HOME STAY IN DEMENTIA (CHESS): HEALTH-RELATED QUALITY OF LIFE IN CAREGIVERS OF PEOPLE WITH DEMENTIA
Authors: Blake C , Merriman N , Mackey L , Fernandez EG , Curran F , Caulfield B , O'Shea D , Doyle R , Power D 
Published: October 2022

Abstract

Background
Caregivers of People with Dementia (PwD) can experience high levels of distress, which can negatively affect their physical and psychological well-being. We explored factors that influence Health-Related Quality of Life (HRQoL) of caregivers of PwD over 12 months.

Methods
Fifty-two PwD and their informal caregivers were recruited by convenience sampling to the “CHESS” Study. Data were collected at five time points over 12 months between April 2017 and November 2019. Mixed model analyses were used to investigate associations of caregiver HRQoL (measured by the EuroQol Visual Analogue Scale; EQVAS) with factors in four domains: 1) Psychological Well-Being (PWB; measures of anxiety, depression, and caregiver distress); 2) Social Capital and Resources (SCR; incorporating access to community-based health services, transportation needs, education level, occupation and living situation of the PwD, and employment status of the caregiver); 3) Physical Fitness and Health (PFH; including the Quantitative Timed Up and Go (QTUG), baseline grip strength, indices of frailty, sensory acuity); and Managing Everyday life with Dementia (MED; incorporating measures of cognition, behavioural disturbances, functional ability, and indices of dependence of PwD.

Results
In the PWB domain, greater levels of caregiver depression (p&lt;0.001) and a greater change over time in caregiver distress related to PwD behavioural disturbances (p=0.008) predicted lower caregiver HRQoL. In the PFH domain, HRQoL was lower for caregivers of PwD who were frail (p=0.04) and had severe comorbidities (p=0.037). None of the factors within the SCR or MED domains reached significance.

Conclusion
This longitudinal analysis elucidates potential predictors of HRQoL in caregivers of PwD. In particular, caregiver depression and distress related to behavioural disturbances in PwD were shown to significantly impact on HRQoL ratings. Caregiver interventions should be tailored to include support for psychological well-being.
218 DEVELOPING CONSENSUS-BASED INTEGRATED NUTRITION CARE PATHWAYS TO PREVENT, IDENTIFY AND MANAGE MALNUTRITION IN IRELAND
Authors: Griffin A , Hedderman A , Mortimer A , McGowan R , Kennelly S , Keller H 
Published: October 2022

Abstract

Background
The expected policy and standards of nutritional care in acute settings in Ireland has recently been developed (Department of Health, 2020). Based on these and international guidelines, integrated care pathways have been proposed by a panel of experts for (i) the transition of nutrition care of adult patients (&gt;18 years) from hospital to community and, (ii) screening and identifying nutrition risk among community dwelling older adults (&gt;65 years). The purpose of this study was to develop a consensus amongst diverse stakeholders for the proposed integrated nutrition care pathways.

Methods
A cross-sectional online survey collected data to identify pathway practices for retention. The survey was adapted to the Irish context based on previous research. Relevant stakeholders including healthcare professionals working in hospital, community and primary care, general practitioners, nurses, registered dietitians, healthcare workers from voluntary community services, and patients/patient advocates were recruited. Participants responded on the relevance and importance of discreet care practices in the proposed Nutrition Care Pathway and a consensus was set at ≥ 80%.

Results
Ninety-seven healthcare professionals and eight patient/patient advocates completed the survey. There was no response from healthcare workers from voluntary community services. Most of the discreet care practices gained consensus ratings ≥80% from healthcare professionals. Among the patient/patient advocates, only 3 pathway elements gained consensus ≥80%.

Conclusion
Healthcare professionals’ agreement with the relevance and importance of the proposed integrated nutrition care pathways offer guidance to prevent, identify, and manage malnutrition among older adults transitioning between care settings or living at home. The opinion of patients/patient advocates and healthcare workers of voluntary community services providers requires further engagement using alternative methodologies.
234 PATIENT COLLABORATION TO DRIVE REFORM: EMBEDDING BRIDGES SELF-MANAGEMENT APPROACH IN AN ACUTE STROKE SERVICE
Authors: Kelly N , McDonnell M , Murtagh N , O'Malley T 
Published: October 2022

Abstract

Background
Bridges Self-Management approach is an evidence-based set of self-management skills, practices and interventions which when implemented can deliver more collaborative and patient-centred care to people suffering stroke [1]. Our acute stroke service underwent training in this approach in 2020. In order to further embed this approach and adapt it to our local setting, patient experiences were captured to help inform ongoing service delivery and quality improvements.

Methods
Ethical approval was granted for this project. Following consent, 20 acute stroke inpatients (length of stay &gt;/=3 days) participated in the study. Patient experiences of their time on the Stroke Unit were sought using a 10-item open-ended questionnaire, which was developed based on the guiding principles of Bridges i.e. what matters most to the person, reflecting on what was/wasn’t going well, what they believe would help them and others.

Results
Thematic analysis was used to analyse the responses, and a number of themes emerged. These include: Loss of autonomy and freedom; Environmental challenges (including boredom, sleep poverty, loss of social interaction, loss of dignity and privacy); Shock, and difficulty adjusting to diagnosis (the importance of being informed and being heard); Loneliness and the role of family and visitors in their recovery journey (coupled with a consistent desire to be in their own home).

Conclusion
Rich data emerged, providing us with a unique insight into the experience of patients. This will compel us to review our service and environment, to tailor changes that matter to patients, and deliver on the Bridges self-management principles of patient inclusion and empowerment.

Reference
1. Jones et al. Building bridges between healthcare professionals, patients and families: A coproduced and integrated approach to self-management support in stroke. Neurorehabilitation. 2016. 39(4), pp. 471–480.
238 THE IMPACT OF COVID-19 ON ACUTE STROKE TREATMENT
Authors: Connor AO , Hobson H , Ryan D , Collins R 
Published: October 2022

Abstract

Background
Acute stroke management is time critical. Treatment options are dictated by time of symptom onset. 2019 Irish National Audit of Stroke (INAS) showed less than 50% stroke cases arrived in hospital within three hours of symptoms and national average rate of thrombolysis was 11%. The median time Door-To-Needle time (DTN) was 56 minutes, and to thrombectomy 93 and 240 minutes ‘direct to mothership’ / ‘drip and ship’ transfer to thrombectomy centre respectively.

Methods
Retrospective review of all stroke FAST calls on our acute stroke database in TUH from July 2019 -2021. Data was analysed pre (up until March 2020) and during COVID-19 pandemic.

Results
FAST protocol imaging was obtained in 78% of cases (464/594). Documented time of symptom onset to CT was 1:50:00 pre-Covid-19 and 2:26:00 during Covid (p&lt;0.001). ED registration to CT was 28mins pre-Covid-19 and 30mins during Covid (p&lt;0.001). The median DTN time was 41mins pre-Covid-19 (n=21), and 54mins during Covid-19 (n=37).

Conclusion
In contrast to INAS COVID-19 report, median DTN times and thrombolysis rates dis-improved at TUH. Trends observed probably reflect multiple factors; patient hesitation to attend ED; patient isolation from family; busier ambulance service; Infection control protocols. We observed small but significant change in door-to-CT time but a more significant increase in DTN. This may reflect time taken donning Personal Protective Equipment (PPE) or general increased ED activity. Understanding the impact of COVID-19 on acute stroke treatment metrics in addition to differences at sites may identify targets for national quality improvement in service delivery.