European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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Results: 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
admission.
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.
P-715
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
consequences,…). 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
P-716
How best to view individual geriatrician mortality data
O. David1. RBCH, NHS
Introduction: 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.
Methods: 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
all “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.
Results: 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.
Conclusion: To remove “routine admissions” from data sets. To view
mortality as an index of activity. To triangulate with readmissions and
post discharge mortality.
P-717
Reducing physical restraints in nursing homes
D. Curto, J. Francisco Tomas, B. Marco. SANITAS BUPA
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.
P-718
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 Cleynenbreugel1, L. De Coninck1–3, J. Spildooren4, E. Gielen1,
L. Vander Weyden1, M. Stas5, J. Flamaing1,6, K. Milisen1. 1Department of
Geriatric Medicine, University Hospitals Leuven, 2Department of OT,
University College Artevelde, Gent, 3Department of Public Health and
Primary Care, KU Leuven, 4Rehabilitation Sciences and Physiotherapy,
University of Hasselt, 5National Health Insurance Association CM,
6Department of Clinical and Experimental Medicine, KU Leuven, Belgium
Background: 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.
Methods: 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.
Results: 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–S259 S217