bluuebunny/crossref_metadata_2025_split huggingface dataset:
102 A REVIEW OF THE REFERRAL PATHWAYS & OUTCOMES TO RAPID ACCESS FRAILTY ASSESSMENT UNIT (RAFAU)IN A REGIONAL HOSPITAL
Authors: O'Keane C , Kemple O , Bocic D , McGlynn J , Donnelly T , Doherty JG , Synott L , Kennedy D 
Published: October 2022

Abstract

Background
The RAFAU is a Multidisciplinary Team including Medical, Physiotherapy and Occupational Therapy, incorporating a fulltime team of OT and PT based in the Emergency Department called RAFT (Rapid Access Frailty Team). It aims to prevent hospital admissions and social crises. There are three main referral pathways, via community (GP, Public Health Nurses, Allied Health Professionals), RAFT-ED, and general medical follow up.

Methods
The data used was from RAFAU attendances between May 2021 and March 2022. Inclusion criteria was age greater than 65 and attendance in person. Exclusion criteria was incomplete data. Data was manually recorded after each attendance using data entry points including age range, methods of and reason for referral, etc. This gave us the raw data to develop information on our cohort. Data analysis was completed using Excel.

Results
A total of 569 patients were seen. The most populous age brackets were 81-85 (28%), 70-75 (25%) and 75-80 (26%) respectively. The vast majority of referrals were from GPs (57%), followed by RAFT-ED (30%). The most common reasons for referral were Medical (34%), Cognitive (27%) and Falls (26%).

Conclusion
A significant number of patients were seen for the first time by the RAFAU MDT. GPs were the major source of referrals which is to be expected as GPs are in more frequent contact with patients and act as gatekeepers to specialist hospital services. The primary referral reasons were also to be expected as these are three issues that are at the core of Gerontology. 173 hospital admissions were prevented in the ED by a combination of the RAFT and Emergency Doctors. There is good rationale for keeping the RAFAU and RAFT-ED team, and where possible expanding their services. This model could easily be expanded to other hospitals.
105 EVALUATION OF A NEW PHYSIOTHERAPY-LED VESTIBULAR SERVICE EMBEDDED IN THE FALLS AND SYNCOPE UNIT
Authors: Bademosi O , Murphy N , Byrne L , Rice C , Briggs R , Lavan A , O’Callaghan S , Kenny RA , Cunningham C , Romero-Ortuno R 
Published: October 2022

Abstract

Background
Clinical presentations in the falls and syncope unit (FASU) are diverse and require a range of skillsets. Vestibular disorders amount to a significant proportion of presentations. In our FASU, we embedded a 0.5 FTE specialist physiotherapist with expertise in vestibular disorders to work alongside medical and nursing staff. We conducted a service evaluation of the activity of this new service.

Methods
Retrospective Service Evaluation Approval was granted by our Research & Innovation Office. Pseudonymised data was collected corresponding to all new FASU physiotherapy service attendances between August 2021 and May 2022. Descriptive statistics were complemented by a binary logistic regression model to establish independent predictors of more than one physiotherapy session being required over the period.

Results
There were 104 episodes recorded by the new service, corresponding to 101 unique patients. Mean age was 67.7 (SD 19.0, range 17-93), and 73.1% were women. 67% were treated and discharged in 1 session. On average, patients had had a mean of 2 falls prior to the consultation (range 0-25). 28.8% were using a walking aid, and 54.8% self-reported fear of falling. 25% of the referrals to the service were due to suspected vestibular disorders, 62% of which were directly treated by the physiotherapy service. The logistic regression model adjusting by age, sex, use of walking aid, number of falls, and fear of falling showed that only referral for vestibular disorder was an independent predictor of patients needing more than 1 physiotherapy treatment (OR 3.91, 95% CI 1.32-11.58, P=0.014).

Conclusion
Vestibular disorders are common in FASU, and a majority can be treated by a specialist physiotherapy service. Repeated vestibular maneuvers are often needed in such patients. A responsive, embedded physiotherapy service in FASU can directly address this need and further evaluation will focus on the impact of this service on avoidance of ED attendances.
109 FRAILTY CARE BUNDLE EAT WALK TALK: MAKING GERIATRIC ATTUNED CARE EVERYONE'S BUSINESS
Authors: Buckley M , Brolly A , Fitzmaurice K 
Published: October 2022

Abstract

Background
Older adults living with frailty are predisposed to functional decline, worsening malnutrition and delirium when admitted to the acute hospital. EAT, WALK and TALK is a comprehensive framework that promotes optimal nutrition and hydration, supports functional recovery and helps prevent delirium [1].
Comprehensive geriatric assessment and interdisciplinary care on an older adult ward can improve outcomes for older adults [2]. However, not all older adults receive care on specialist wards. The frailty care bundle framework could be utilised on general medical wards to apply older adult attuned principles of good care.

Methods
A quality improvement initiative using PDSA was undertaken. Engagement with stakeholders was made through the Quality and Patient Safety Committee. The overall aim was to prevent hospital associated functional decline by increasing mobility, improving nutrition and cognitive engagement on general medical wards. The blue plate initiative, patient mobility and delirium screening was audited.

Results
The audit showed a 13.3% reduction in patients screening positive for delirium and a 100% increase in the use of delirium care plans. Nutritional intake had improved by 50% with the addition of blue crockery. Baseline mobility audit showed gaps in communication between health professionals. Whiteboards were introduced to address this.

Conclusion
The EAT WALK and TALK care bundle prioritises the critical components of good care for the older person living with frailty. The audit data shows improvement in care processes and outcome measurements.

References
1. Mudge AM, et al. Eat Walk Engage: An interdisciplinary Collaborative Model to Improve Care of Hospitalized Elders. American Journal of Medical Quality 2015. Vol. 30(1) 5–13.
2. Ellis G et al. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane database Syst Rev. 2011(7): CD006211.
122 EVALUATING THE IMPLEMENTATION OF CLINICAL PHARMACIST SERVICES IN A POST DISCHARGE HOSPITAL-BASED REHABILITATION WARD IN IRELAND
Authors: Flanagan R , Quinn O 
Published: October 2022

Abstract

Background
The number of people over 60 years is predicted to double by 2050. Medicines play a significant role in a patient’s recovery and in the management of many acute and long-term conditions. Patients are living with chronic diseases which require management with medication, such as diabetes, stroke, and cancer. Patients over 60 years are more vulnerable to adverse effects of poly-pharmacy due to declining renal and hepatic function, reduced lean body mass and functional capabilities. Medications should be prescribed appropriately with the intention to have a favourable outcome, to improve mortality, morbidity, and the quality of life of the patient. Inappropriate prescribing of medications leads to poly pharmacy, adverse drug reactions, poor adherence, prolonged recovery time and poor participation in rehabilitation programmes.

Methods
Clinical pharmacy services were provided to patients in the rehabilitation ward. Medication reconciliation, clinical medication review of medications, participation in MDT meetings, discharge planning including education on medication regimes with patient and primary care services. All interventions were recorded at each stage.

Results
The average number of medications on admission was eleven. On completion of medicine reconciliation, many changes were intentional. 19% of patients had an unintentional change to their medications. On completion of a clinical review 156 drug related problems were identified. 77% of recommendations were accepted by medical team. 57.5 % of medications were deemed a STOPP medication and 20.8 % were deemed a START medication. On discharge the average number of medications prescribed was six. This represented a 40% reduction in the number of medicines prescribed on discharge.

Conclusion
The inclusion of a clinical pharmacist as a member of the multidisciplinary team on a rehabilitation ward allows for a comprehensive review of patient’s medications. This optimises medications, identifies drug related problems, reduces the pill burden, aids adherence, reduces the possibility of adverse drug reactions and promotes medication safety.
125 STROKE SURVIVOR AND CARER EXPERIENCES OF NAVIGATION OF STROKE SERVICES AND INFORMATION IN IRELAND: AN EXPLORATORY QUALITATIVE INTERVIEW STUDY
Authors: Sexton E , Fowler K , Byrne E , Bennett K 
Published: October 2022

Abstract

Background
Patient navigation of stroke services is challenging, as survivors have diverse and complex needs, and clear care pathways are often lacking, particularly in the post-acute phase. Exploring the views of stroke survivors and main carers is critical to understanding these navigational challenges.

Methods
In-depth semi-structured interviews were conducted online or by phone with stroke survivors (n=16) and main carers (n=13) recruited through voluntary organisations and social media. Participants with communication or cognitive difficulties were included, and provided with accessible information materials. Interviews were audio-recorded and transcribed. Framework analysis was used, involving data familiarisation, coding, development of an analytic framework, charting and interpretation. Ryvicker’s (2018) behavioral-ecological conceptual framework for patient navigation was used to inform the analytic framework.

Results
Barriers to successful patient navigation at the healthcare system level included complex and unclear eligibility criteria for services and entitlements, including arbitrary age limits; geographical variation; and waiting times for services, particularly rehabilitation. Having a skilled or knowledgeable advocate, such as a family member with experience of the healthcare system, was a key enabling factor. Survivors and carers had to be pro-active and “push” or “battle” for needed services and information. Navigation often involved a substantial administrative burden, which survivors and caregivers had to manage in addition to the demands of the stroke itself, the recovery process, and in many cases other co-morbidities. Healthcare provider factors that supported navigation included clear communication with survivors/carers about services and the stroke itself. Staff who specifically supported care co-ordination were helpful, but this tended to be ad-hoc and limited in availability.

Conclusion
Dedicated staff to support patient navigation across the care continuum could make a significant difference to stroke survivor access to services and consequently outcomes. Clearer, standardised and more person-centred referrals pathways, that are widely publicised and understood, would also improve access.
128 TO BLEED OR NOT TO BLEED: THE INTRACEREBRAL HAEMORRHAGE MANAGEMENT QUESTION
Authors: Murphy B , Meagher MK , Noone I , Cassidy T 
Published: October 2022

Abstract

Background
Intracerebral Haemorhage (ICH) accounts for 9-27 per cent of all strokes. There are high rates of early case fatality and poor functional outcome. Clear guidelines and pathways exist around the management of ischaemic stroke. Pathways for the haemorrhagic stroke patient are lacking. Good evidence exists for early Blood Pressure (BP) management, reversal of Oral Anti-Coagulation (OAC) and admission to a Hyper-Acute Stroke Unit (HASU) in terms of improving outcomes.

Methods
A retrospective cohort analysis was performed, looking at all the presentations with ICH over one calendar year. The factors measured included time to CT Brain, BP at presentation, documented target systolic BP of under 140mmHg, time to treatment of hypertension, number on OAC, OAC reversal, time to OAC reversal, admission to HASU. The findings were compared to standards outlined in the European Stroke Organisation and American Heart Association’s ICH management guidance.

Results
76 patients were include (40 female). Mean age was 73, age range 34-93. median age 77. 44 were hypertensive on admission (20 info unavailable [u/a]). Of the 44, 34 had a documented target BP under 140mmHg (12 = n/a, 20 u/a). Time to treatment of hypertension was within 60 minutes for 3 patients. Of those that were hypertensive, 57 per cent were 75 or younger. 16 were on an OAC, of which 11 were appropriately reversed (3 u/a). Of the 11, 2 were reversed within 90 mins (7 u/a). Of those on an OAC, 75 per cent were over 75. 32 were admitted to HASU within 72h (all of these made it within 24h), (10 did not reach HASU, 3 reached HASU bed after 72h, 31 u/a).

Conclusion
Management of ICH is variable and suboptimal. Our goal is to produce a written pathway which will be incorporated into our hyperacute stroke document, with a plan to re-audit.
129 RE-THINKING THE MEMORY CONSENSUS MEETING: A QUALITY IMPROVEMENT INITIATIVE
Authors: Costello M , Munawar N , Bruce I , Crosby L , Burgui D , Finnegan M , McKenna MC , Hutchinson S , Crowe C , Greene E , Leori I , Robinson D 
Published: October 2022

Abstract

Background
As part of our memory clinic service, weekly consensus meetings are held to allow for multidisciplinary diagnostic evaluation of new cases. As part of a local Quality Improvement (QI) initiative, we reviewed how this meeting could be streamlined to maximise efficiency and improve diagnostic accuracy in light of increasing referrals and patient complexity. Here we describe the development and initial implementation of this QI project.

Methods
A structured QI approach was taken to develop SMART (Specific, Measurable, Achievable, Realistic, Timely) goals. All professional stakeholders (from disciplines including geriatric medicine, neurology and psychiatry of later life) who attend the weekly consensus meeting were surveyed anonymously with a response rate of 80% (n=8). Information was gathered on areas that worked well, areas that needed improvement and suggestions for meeting enhancement. In addition, participants were asked at a single meeting to subjectively rate the complexity of eleven cases presented into the following categories: low, medium and high. Data were collated and presented to the memory clinic staff for further refinement.

Results
Four key actions were identified for implementation: formal allocation of a meeting chair, improvement of access to imaging from outside hospitals, revision of current proforma to streamline case discussions, and proposal to discuss patients in order of new assessment, return assessment and review of significant results. During the rating of case complexity, there was substantial variation among respondents.

Conclusion
This initial phase has been used to develop SMART goals to improve the consensus meeting structure. We identified that patient complexity would be an inefficient method to order case discussion. Implementation of action steps are ongoing, with positive feedback from staff to date.
132 STRUCTURED REFLECTION ON POTENTIAL IMPACTS FROM HEALTH INEQUALITIES AND UNCONSCIOUS BIAS ON CLINICAL DECISION MAKING AT A MOVEMENT DISORDER CLINIC
Authors: Trolan C 
Published: October 2022

Abstract

Background
Healthcare inequalities can result in avoidable, unfair and systemic differences in health between different groups of people. Clinicians have unconscious biases that can impact on their decision making. The General Medical Council's Good Medical Practice: Maintaining Trust Domain 4, states that doctors must “treat...patients fairly without discrimination”. The Reflective Practitioner should use a variety of tools to support structured reflection. The movement disorder service in question provides care for a mix of urban and rural communities with a wide range in deprivation indices.

Methods
A single doctor's referral patterns and prescribing decisions for parkinsonian syndromes was retrospectively analysed for 99 consecutive attendees at a mixed face-to-face and telehealth clinic service over six weeks. Harvard Implicit Association Tests were completed to assess for unconscious biases. Patient characteristic data are available for: age, sex, religion, skin colour, sexual orientation, primary language, deprivation index, Trust of residence, weight, hearing loss, visual loss, Rockwood Clinical Frailty Scale, Hoehn and Yahr staging and educational attainment. Clinical decision making data are available for: referral patterns to physiotherapists, occupational therapists, speech and language therapists, continence services, psychiatry services, bone mineral density measurement, specialist nursing service, brain imaging and prescribing decisions made.

Results
The sample had 60 males, 38 females and 1 male-to-female active transition. Deprivation indices ranged from the 64th to 889th least deprived postcodes (of 890). Only one non-white attendee. Two non-heterosexual attendees. Primary language for all was English. Mean age 76.72years. Mean Hoehn and Yahr stage 2.49. 25.25% are living with dementia. 55 attendances were face-to-face. Prescribing changes were more likely to occur through telehealth clinics. Women were more likely to be referred to physiotherapy and psychiatry. Patient religion may have impacted prescribing decisions.

Conclusion
Open and honest reflection can improve patient care by identifying health inequalities and through using a metacognitive approach to clinical decision making.
173 ASSOCIATIONS BETWEEN CARDIOVASCULAR SIGNAL ENTROPY AND FUTURE FALLS, SYNCOPE, AND FEAR OF FALLING
Authors: Knight SP , Davis J , Duggan E , Kenny RA , Romero-Ortuno R 
Published: October 2022

Abstract

Background
Previous studies have reported impaired blood pressure (BP) control during standing to be associated with future falls and syncope. Increased complexity in BP signals has been shown to be associated with poorer cognitive performance, frailty, and increased mortality risk. The aim of this study was to investigate associations between the level of complexity in beat-to-beat BP data during an active stand challenge and future occurrence of falls, syncope, and fear of falling in a cohort of older adults from The Irish Longitudinal Study on Ageing (TILDA).

Methods
Beat-to-beat BP was continuously measured during an active stand protocol at wave 1 of TILDA (2009-2011). Complexity of BP signals was quantified using sample entropy (SampEn) during rest, stand, and recovery sections of data. Self-reported occurrences of falls, syncope, and fear of falling were collected at waves 2 to 6 (2012-2021). Comprehensively controlled modified Poisson modelling was employed to investigate associations.

Results
Complete data were available for 4714 individuals (age: 61.0±8.8 years; 55.3% female). Higher BP SampEn during rest and stand was associated with increased risk of future recurrent falls (IRR=1.34, p=0.003, and IRR=1.22, p=0.044, respectively). Higher BP SampEn during recovery was associated with increased risk of future syncope (IRR=1.84, p=0.041). In a sub-cohort of participants aged 65+, higher BP SampEn was associated with increased risk of future fear of falling (N=1552; IRR=1.25, p=0.037). All reported IRRs are per one unit of SampEn.

Conclusion
This study reports significant associations between higher complexity in BP data during an active stand protocol and increased risk of future falls, syncope, and fear of falling over ten-year follow-up.
176 EXPLORING THE PREVALENCE AND PRESENTATION OF FRAILTY IN AN IRISH EMERGENCY DEPARTMENT – A POINT PREVALENCE STUDY
Authors: O'Neill S , McShane N , Nelson C 
Published: October 2022

Abstract

Background
In Ireland, frailty is routinely identified in the Emergency Department (ED), however its prevalence is not well defined. This contrasts with the prevalence of frailty in the older adult population living in the community setting, where the prevalence of frailty has been defined as 14% in the over 65 population and 33% in the 75 and over (TILDA, 2020). The aim of the study is to explore the prevalence and presentation of frailty in the older adult population attending ED of a model 3 hospital in Ireland.

Methods
In August 2021, a point prevalence study was undertaken in the ED over 14 days, covering a 24-hour period, applying retrospective documentary and observational data analysis. Measures used to identify frailty included: Think Frailty and Clinical Frailty Scale (CFS) version 2.0.

Results
2,582 individuals attended ED over a 2-week period. 22% were aged 65 and over, of which, 37.5% were aged 65 – 74 and 62.5% were aged 75 and over. 60% were admitted and 40% were discharged. Of those identified as living with frailty – 24.8% were identified to be living with severe/very severe frailty (CFS 7 – 8); 19.5% with moderate frailty (CFS 6), and 35.66% with mild/very mild frailty (CFS 4 – 5). The majority of those identified at CFS 1 – 3 were aged 65 – 74. The identified frailty syndromes included, polypharmacy (38.5%), reduced mobility (30.3%), falls (20%), dementia (6%), Delirium (5%), Incontinence (0%).

Conclusion
The results indicated that 80% of the identified cohort were living with frailty (CFS 4 – 8). Frailty status and advancing age were associated with a longer length of stay in ED and a subsequent admission. Dominant frailty syndromes included polypharmacy and reduced mobility; frailty syndromes such as delirium and incontinence appear to be underrepresented, which may be influenced by the absence of routine identification in the ED.
180 DIETITIAN-LED, EARLY IDENTIFICATION OF MALNUTRITION RISK IN THE EMERGENCY DEPARTMENT IMPROVES INTERVENTION RATES
Authors: Cronin L , Pillay I 
Published: October 2022

Abstract

Background
Frailty At The Front Door (FATFD) teams are ideally positioned to facilitate screening for risk of malnutrition in the frail older person. The aim of this quality improvement initiative is to improve malnutrition risk identification and first point of contact intervention, in a frail older Emergency Department (ED) population.

Methods
Dietetic assessment was initially triggered using a non-standardised screen in a Comprehensive Geriatric Assessment (CGA). Referral to dietetics was triggered if there was a ‘yes’ response to - have you lost weight and/or do you have a poor appetite? Patient demographics were prospectively entered onto Excel. A shorter CGA which included a validated MST screen was developed. All patients at risk of malnutrition were referred for dietetic intervention. Patient demographics, MST and Clinical Frailty Score (CFS) score of referred patients were prospectively entered onto Excel. Results were analysed using descriptive statistics.

Results
Pre-standardised screen, an average of 7 patients per week received an intervention. The mean(SD) age was 83.8(6.9) years. The male to female ratio was 1:1.5. No information was available on malnutrition risk or CFS. Post standardised screen, The mean(SD) age was 84(7) years. The male to female ratio was 1:1.2. Mean(SD) CFS was 5 (1.5). An average of 10.3 patients received an intervention per week.

Conclusion
Prioritisation of malnutrition risk screening was successful within a shortened CGA. A 47% increase in dietetic intervention was achieved. This has created an opportunity to further develop specialist pathways for example: Tube Feeding and Oral Nutritional Supplements.