who will be working with it and will have to rely on its proper
Delayed discharges and social isolation in countries with ageing
populations: England versus Portugal
F. Landeiro, A.M. Gray, J. Leal.
University of Oxford
Social isolation leads to detrimental health effects in
older people and to increased use of healthcare resources. At the same
time, many acute hospital beds are occupied by older patients that are
medically fit for discharge but cannot be transferred back to the
community. We compared the impact of social isolation on delayed
hospital discharges and corresponding costs in Portugal and England.
Two prospective cohort studies were conducted on
proximal femoral fracture patients aged 75 and older admitted over
a one-year period to Trauma Units in two teaching hospitals in Lisbon
and in Oxford. A generalised linear model with a log-link and gamma-
variance was used to assess the number of days of delayed discharges
in relation to level of social isolation.
In Portugal, 30.6% of the patients had a high risk for social
isolation or were socially isolated at admission whereas in England
75.3% had this same risk for isolation. Delayed discharged accounted
for 11.5% of the total length of stay in Portugal and 43.7% in England
(6.8 and 8.4 for excess bed days per patient with a delayed discharges,
respectively). Having a higher risk for social isolation increased the
number of days of delayed discharges in both countries (2.6 in Portugal
and 3.1 in England) and corresponding costs.
The reduction in social support networks increases
unnecessary consumption of acute hospital beds. A restructuring in
the provision of post-acute care services is necessary in order to meet
the demands of an ageing and isolated population.
Diurnal variation of hip fracture admission in the West Midlands,
, J. Tsang
, V. Qurashi
Russsells Hall Hospital, Dudley,
Southampton Medical School, Southampton, UK
Hip fracture is an orthopaedic and medical emergency.
Patients, usually elderly, have many comorbidities and polypharmacy.
They need to be optimised and have surgery on the day of or the day
after admission. The more the delay in surgery the worse the
To study the diurnal variation of admissions of hip fracture
patients in a UK teaching hospital .
Retrospective analysis of the electronic records of all
consecutive admissions of patients with hip fracture in a 6-year
period between August 2009 and July 2015 in a UK teaching hospital.
Data were downloaded to an excel sheet. Descriptive statistics were
used to analyse the data.
In the study period 2932 patients were admitted; patients
with incomplete data were excluded. There were 807 (28%) male and
2121 (72%) female with a mean age of 79.9 and 82.6 respectively.
77% of patients were admitted between 09:00
22:00 hours and 16%
patients between 00:00 and 08:00hours.
There are more hip fracture admissions during the
daytime as older people are likely to have more risk of falling in the
daytime hours when they are awake and mobile.
There is a lower number of admissions during the night possibly
because there is less number of falls as most patients would be asleep.
Some of those who fall may prefer not to telephone the ambulance
during the night and wait till the morning. Also some patients are
unable to get off the floor and stay on the floor until they are found
next day by a family member, visitor or a carer and then brought to the
In this UK study, more than three quarters of hip fracture
admissions occur between 9 am and 9 pm; one in six patients were
admitted between 00:00 and 08:00hours.
Knowledge of the diurnal variations in hip fracture admission to
hospital may help orthopaedic surgeons and hospital managers to
plan the work force, theatre time and facilities during different times
of the day to ensure timely operation and make best use of resources.
Quality of discharge letters for older patients discharged from
secondary care to Specialist Care Centres (SCCs)
, T. Galt
, B. Lakkappa
Community Elderly Care Service,
Northamptonshire Healthcare NHS Foundation Trust,
County Council, Northampton, United Kingdom.
Elderly patients admitted to SCCs from the acute hospitals
usually have multiple morbidities and polypharmacy. Medicines
reconciliation identifies errors and omissions which can cause risk
to patients, possibly resulting in hospital readmission. This audit
aimed to quantify issues identified and measure the risks.
65 patients (range 67
99 years) were admitted to the SCCs
from two acute hospitals over 6 weeks in spring 2015; medicines
reconciliation performed by the pharmacist or pharmacy technician.
We collected data on numbers of discrepancies between previous GP
record and the hospital discharge letter. We assessed the risk
associated with each discrepancy using the National Patient Safety
Agency Risk Matrix.
91 discrepancies were identified, affecting 88% of patients.
This included previous medicines omitted from the discharge letter or
no reason given for stopping (57%), new medicines with no indication
stated (70%), incomplete allergy information (17%), insufficient
supplies sent with patient (45%). 11% of discrepancies were low risk,
88% moderate/high risk, and 1% extreme risk. Time spent resolving
discrepancies was 16 minutes per discrepancy or 22 minutes per
Hospital discharge letters for elderly patients have
incomplete information about changes made to patients
during admission. This could lead to inappropriate future prescribing
and takes time to resolve which could be used in other clinical tasks.
Discharge to home care
s transition process
L.N. Hugo, M.J.A. Berta, M.S.F. Carlos, M.C.P.M. Cidália, F.E.R. Liliana,
R.S.F. Vânia, F.S.A. Sérgio, C.C. Marlene, C.G.R. Isabel, M.C.M. Alda.
Discharge preparation requires healthcare profes-
sionals to produce an effective and coordinated response in multiple
levels of care, ensuring cost-effective use of resources. Due to high
levels of dependency after a neurological event, we developed a
program to ensure discharge to home care in safety by optimizing
transition to a caregiver role, ensuring better outcomes in long term.
Sample selection was obtained from families of patients
with high level of dependency, that showed potential to assume a
caregiver role. Intervention consisted in promoting awareness of
s needs through demonstration of care by the nurses.
Afterwards, information was provided to the family, and skill training
of the caregiver was evaluated through checklist, requiring fulfillment
of the checklist before being discharged. Articulation with community
resources would be activated to ensure the family was closely
accompanied. A one-month follow-up would be done after discharge.
Our target patients integrated Diagnosis Related Groups
42/45. During evaluation period, 83 dependent patients were
discharge to home care with an informal caregiver, from whom 44
answers were obtained. From the data obtained, 80% felt prepared
and confident in their new role. Follow-up results showed 83% of the
patients discharged to home care with a caregiver did not have a
subsequent hospitalization, which leads to decrease in overall costs
when compared to discharges to continuous care units.
This project lead to a systematized programming
of the discharge, capacitating the families to a level where they felt
secure and confident to assume their new role.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29