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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.

Key conclusions:

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,

United Kingdom

A. Michael


, 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. Moor


, 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

optimizing caregiver

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.

CHUC-HUC, Portugal


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

the patient

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.

Key conclusions:

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