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45% of 28 day readmissions were within seven days of

discharge; over half of seven day readmissions were with the same

or a recurring problem. 27% of all readmissions were with a

recurrent problem, the majority being recurrent falls. Under half of

all patients were readmitted under the care of the HCOP department,

and only 3.3% under the discharging Consultant from the previous


Key conclusions:

The HCOP department

s readmission rate is con-

sistently higher than other medical specialties at our trust. Our

patients are frail with complex needs, requiring significant social

support in the community. Our action plan includes facilitating

patients readmitted within 7 days of an HCOP inpatient stay to be

transferred back to their discharging ward, enabling teams to reflect

on reasons for readmission, whilst ensuring continuity of care.


Information technologies in care homes

D. Curto, B. Marco, J. Francisco Tomas.

Sanitas-SLA, BUPA

Clinical information, to achieve the best Quality of care and to assure

Clinical safety is fundamental. The way it is recorded, stored, and

benchmarked is important for a company that want to improve QoL of

elderly. Taking in account that residents had a lot of comorbidity,

polypharmacy antipsychotics

developing a powerful IT system is the

way to improve this quality Sanitas Mayores has 39 care homes around

Spain, taking care of 4800 residents. The company has developed

through these last 10 years a consistent IT system that allows clinicians,

deliver high quality of care. Paper is not used. All clinical information

is recorded into Resiplus (IT System) where each clinician record as

much information is possible of each resident. All procedures, are

organized and regulated in the management system. Clinicians must

be as much exhaustive as its possible (pressure ulcers, falls and its


). With all this data, from the IT department has been

possible to built a clinical indicators platform. These clinical indicators

measure different aspects of clinical care. Clinicians can take clinical

decisions in order to deliver best care. Also it

s possible to benchmark

different care homes. Recently, a new development has been

introduced. A clinical dashboarh has been built. This Dashboard

contains critical indicators considered KPIs. Clinical information

journey from the resident to a clinical dashboard is the way, a care

home company can obtain the best quality information in order to

deliver best care and assure the best quality of life of residents


How best to view individual geriatrician mortality data

O. David





Hospital mortality metrics are increasingly important

and political. UK Geriatricians are asked to audit their individual data

but there is no prescription on how to do this.


A rolling, monthly, self-populating, Excel data and graphics

sheet was formulated from routine hospital data. Variation between

those working part time and those with a heavier work load was to be

expected. To better compare consultants, we viewed mortality as a

percentage of discharges and death activity. We then had to remove


routine admission

data to exclude fitter patients attending

Day hospital or community beds to focus on our main area of interest,

acute geriatrics admissions. We also had to consider who might be

readmitted or die shortly after discharge for a fuller picture.


Mortality trends in the department were surprisingly stable

over the last 5 years. When graphically represented, the granularity

of individual monthly trends, reassuringly evened out. We had an

average 30 day post discharge mortality rate of 4% (as a function of

activity) with an average per consultant of only 2 per month. This

compared with an in-hospital mortality rate of 10% (an average per

consultant of 5 per month). The 30 day readmission rate was 15%

(an average per consultant of 8 patients per month). We wish to

benchmark ourselves, while recognising the marked variation across

European health care organisations.


To remove

routine admissions

from data sets. To view

mortality as an index of activity. To triangulate with readmissions and

post discharge mortality.


Reducing physical restraints in nursing homes

D. Curto, J. Francisco Tomas, B. Marco.


Regular use of physical restraints in care homes has been regarded

implicit-explicitly as an indicator of poor quality of care. Thousands of

people worldwide, especially those who suffer dementia, are still

affected by these practices. In many countries physical restraints

are too often used for organizational convenience, ignorance of its

consequences and possible alternatives, or due to understaffed

homes. Prevalence of use varies considerably between countries. In

1997 Spain was reported to have a staggering 39.6% of residents

physically restrained at least once daily. Other countries, (China, Italy,

etc) face similar challenges. 2016-Sanitas Mayores (BUPA) together

with Maria Wolff Foundation published the results of a longitudinal,

multicomponent, multilevel psychosocial and training program

aimed at delivering person-centered care for people with dementia

with the objective (among others) of reducing physical restraints.

Analyzing a sample of 7,657 subjects from 41 nursing homes showed

that the frequency of residents having at least one restraint was

reduced from 18.1% to 1.0%. Use of benzodiacepines was reduced,

with no significant changes in mortality. The rate of total falls

increased from 13.1% to 16.1% with no significant increase in

injurious falls. The group of residents most restrained before the

program were people with dementia (29%). There was no significant

difference in use of bed rails at both study waves when the total

samples were compared (43.5% vs. 41.7%). A global decrease in

psychotropic medication prescription was recorded in people who

had dementia.


Development of a care model for transmural and multifactorial

patient-centered falls prevention to improve compliance by

community-dwelling older persons with high risk of falls

E. Van Cleynenbreugel


, L. De Coninck



, J. Spildooren


, E. Gielen



L. Vander Weyden


, M. Stas


, J. Flamaing


, K. Milisen




Department of

Geriatric Medicine, University Hospitals Leuven,


Department of OT,

University College Artevelde, Gent,


Department of Public Health and

Primary Care, KU Leuven,


Rehabilitation Sciences and Physiotherapy,

University of Hasselt,


National Health Insurance Association CM,


Department of Clinical and Experimental Medicine, KU Leuven, Belgium


Although multifactorial intervention studies demon-

strate falls reduction, this is not always guaranteed due to low therapy

compliance by older persons at risk of falls. We aimed to develop a

transmural and multifactorial patient-centered care model for older

persons visiting a falls clinic.


Development of the care model First, a literature review has

been conducted focusing on clinical and organizational aspects of

falls clinics and compliance. Second, a qualitative study on clinical

and organizational aspects was organized with clinicians of the falls

clinic and referring primary care professionals. Third, a prospective

observational study was conducted to measure patient characteristics

and flows in the falls clinic. Based on the former steps, a care model

was developed and adapted after discussion with all health care

professionals involved, which was pilot-tested during 4 weeks.


The key components of the final care model are: (1) an

information brochure about the falls clinic and a self-administered

questionnaire about the patients falls

history that is sent to each

patient before consultation, (2) a multidisciplinary and multifactorial

falls assessment, (3) discussion of the assessment results within the

multidisciplinary team, (4) patient involvement in prioritizing the

multifactorial recommendations, (5) an electronic communication

platform that supports transmural data transfer, (6) a case manager

enhancing patient compliance by follow-up visits and phone calls and

Poster presentations / European Geriatric Medicine 7S1 (2016) S29