108 / 290
Results:
The rate of holistic assessment for newpatients increased from
10% to over 30%. Rates of pressure ulcer screening, nutritional assess-
ment, and referral for voluntary support increased. Avoidable pres-
sure ulcers decreased by 87.5% between May 2015 and January 2016.
Conclusion:
This project has shown significant improvements in
pressure area care. Sustainability has also been shown. A further PDSA
cycle is underway to introduce a Frailty Tool to the community teams.
The author has been funded to work two days a week implementing
similar improvements within other teams.
P-275
“
Hot clinic
”
effects of outpatient comprehensive geriatric
assessment on survival and hospital admission avoidance
S. Saber, P. Vansia, S. Haxhija, B. Musaddaq, L. Talmaci, K. O
’
Gorman,
M. Rahman, A. Wu, R. Mizoguchi.
Royal Free Hospital, London, UK
Objectives:
HOT clinic is a
“
one stop clinic
”
which is part of Triage and
Rapid Elderly Assessment Team (TREAT), aim to address patient
’
s
needs rapidly following approach of comprehensive geriatric assess-
ment (CGA) with community teams to ensure appropriate care in
place.
The criteria is patients with complex needs, exacerbation of chronic
conditions requiring immediate management to achieve purpose of
admission avoidance and improve survival.
Methods:
A retrospective study of 8 months period pre and post
introduction of Virtual Clinic (telephone call) carried out looking at
patient attended HOTclinic to confirmwhether CGA has been assessed
appropriately.
Results:
Total number of 475 patients attended HOT clinic, average age
was 85 ± 9.
The main source of referral was from GPs (51%) followed by TREAT
(27%) and Emergency department (15.5%).
Number of patients admitted in hospital from HOT clinic was 4.2%
(n = 20), 17.6% (n = 84) patients admitted in hospital within 30 days
post HOT clinic attendance, average length of stay was 10 days.
Median waiting time for HOT clinic was same day. The mortality post
attendance of HOT clinic was 0.63%(n = 3).
3.6%(n = 96) functional improvement observed post virtual clinic
cohort compare with 25.2% (n = 68) pre virtual clinic cohort.
Conclusion:
Patients were seen promptly, with significant reduction
inmortality rate and functional improvement observed post HOTclinic
attendance.
Both admission and readmission rate remained low which completed
the concept of admission avoidance. Reduce number of follow up has
shown after introduction of Virtual clinic.
P-276
Multidisciplinary team. Geriatricians and urologists collaboration
F.A. Suescun
1
, J.J. Camacho
2
, G.A. Polanía
1
, Y.F. Zuluaga
3
.
1
Unidade Local
de Saúde do Norte Alentejano, Portugal;
2
Hospital Infanta Cristina de
Badajoz, Spain;
3
Hospital de Santo Espírito da ilha terceira, Portugal
Introduction:
the collaboration between urologists and geriatricians
ensures that each patient receives highly coordinated, comprehensive
care. Bladder cancer, illustrates well the association between cancer
and aging and it
’
s the fourth most common malignancy in men.
Method:
Case Report. An 82-years-old man with a history of bladder
hernia and bladder cancer non-operated dating back six years,
was admitted to the emergency room due to macroscopic hematuria,
abdominal pain and malaise for 24 hours. Computed Tomography
images revealed a voluminous inguino-scrotal hernia containing much
of the bladder with a thickening area of the wall of 67 × 34 × 64 mm
(image#1), the Complete Blood Count showed hemoglobin 8,2 g/dL,
and the Blood Chemistry showed Creatinine 3,4 without other relevant
findings. The patient was admitted in the urology service after clinical
stabilization, the case was discussed by urologists and, despite high
perioperative mortality risk due to all the existent comorbidities
including aortic abdominal aneurism, COPD, Hipertension, isquemic
heart disease, atrial fibrillation and Diabetes was proposed to partial
cystectomy and hernia repair surgery as the only definitive way to
relief the pain and control of the hematuria. The case was consulted
with geriatrics.
Results:
A comprehensive geriatric assessment and a multidisciplin-
ary team agreed with the patient a non-surgical approach. He was
discharged home with the complete support of the hospital and home
care.
Conclusion:
Geriatrics strategy begins with the patient
’
s primary
concern; includes a review of the care plan; considers patient pre-
ferences, available medical evidence, prognosis, benefits and harms;
and communicates options and treatment choices with the patient.
P-277
Self-rated health and mortality in the polish elderly
–
PolSenior
project
A. Szybalska
1
, P. Slusarczyk
1
, A. Skalska
2
, K. Broczek
3
, M. Puzianowska-
Kuznicka
4,5
, M. Mossakowska
1
.
1
International Institute of Molecular and
Cell Biology in Warsaw,
2
Jagiellonian University Medical College, Cracow,
3
Medical University of Warsaw,
4
Mossakowski Medical Research Centre,
Polish Academy of Sciences,
5
Medical Centre of Postgraduate Education,
Warsaw, Poland
Introduction:
Prognostic value of self-rated health (SRH) on elderly
mortality was observed in many surveys. We analyzed this association
in a representative cohort of the Polish elderly.
Methods:
The PolSenior project was conducted between 2007 and
2012 in a sample of 2,412 females and 2,567 males aged 65 years and
over. Evaluation of SRH was performed in respondents with preserved
cognitive function andmeasured using Visual Analog Scale (range 0
–
10
points), where 0 meant the worst and 10 the best imaginable health
status. The score of 0
–
3 points was interpreted as poor, 4
–
6 as fair, and
7
–
10 as good SRH. Socio-economic factors, functional status, vision and
hearing acuity, morbidity and life-style factors were also accounted for.
Results:
During the 5-year period, 730 females (30%) and 1,009
males (39%) have died. Significant hazard ratios for all-cause mortality
were observed for females and males with poor (HR 2.48, 95%CI [1.83
–
3.37]; HR 2.62, 95%CI [2.04
–
3.36], respectively), as well as those
with fair SRH (HR 1.29, 95%CI [1.03
–
1.60]; HR 1.29, 95%CI [1.10
–
1.52],
respectively) as compared to those with good SRH. Cox proportional
hazards regression model adjusted for all covariates confirmed that
SRH was associated with mortality in females, but not in males.
Significant differences in the risk of mortality were observed only
between females with poor and good SRH (HR 1.77, 95%CI [1.11
–
2.82]).
Key conclusions:
SRHmay be a valid predictor of all-causemortality in
elderly females, but not in males. Implemented under publicly-funded
project no. PBZ-MEIN-9/2/2006, Ministry of Science and Higher
Education.
P-278
Improving identification of depression in hospitalised older people
J. Vale
1
, J. Stephenson
2
, N. Sevdalis
3
.
1
Taunton & Somerset NHS
Foundation Trust, Taunton,
2
Royal Devon & Exeter NHS Foundation Trust,
Exeter,
3
King
’
s College, London, England
Introduction:
Depression seriously impacts on older people, increas-
ing morbidity and mortality, caregiver burden and hospital readmis-
sion. Despite screening being nationally recommended, it frequently
remains unrecognised and untreated in older people.
Aims:
To improve identification of depression in hospitalised older
people.
Methods:
Baseline assessment of current care was undertaken.
Stakeholder analysis and engagement was conducted with staff and
patients. Interventions included:
•
Environmental restructuring
–
development of a depression
screening proforma incorporating the four question Geriatric
Depression Score (GDS-4)
•
Education
–
about depression
’
s impact and importance of
assessment
•
Persuasion
–
to use the proforma and improve patient outcomes
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S102