European Geriatric Medicine - Supplement 1 - Volume 7

P-741

Continuity of primary care and emergency department utilization

among elderly people

G. Sarmento, F. Leal-Seabra, M. Brinquinho, R. Veríssimo, A. Oliveira.

Internal Medicine Department of Centro Hospitalar Vila Nova de Gaia/

Espinho

Introduction:

Numerous studies have suggested that better con-

tinuity of care (COC) can lead to fewer emergency department (ED)

visits. The loss of information is a constant demand for unnecessary

services. This study aimed to determine whether the association

between lower COC for older in ED and increased health care

utilization may be apparent in a health care system that lacks a

referral system.

Material and methods:

In a study conducted in November 2015

were evaluated episodes of ER, setting as lack of continuity of care

episodes with discharged to home. The variables analyzed were:

gender, age, the color of Manchester Triage, cause administrative,

diagnosis by ICD9, destination, and readmission. We used descriptive

statistics and chi-square were used for a p-value < 0.05.

Results:

The number of older episodes was 33.9% (8037/2729).

The most common profile was women with 81 years old, which

diagnosis was heart failure, screened with yellow color and discharge

to home. COC represented 56.9% of the episodes. The readmission

to the ED was 12.8%. Determinants associated with episodes with-

out COC were traumatic causes (RR = 1.56 CI = 1.31

–

1.86), low severity

(RR = 1.58 CI = 1.37

–

1.83) and readmission to ED (RR = 2,12; CI = 1.74

–

2.62).

Conclusions:

This study indicates that lower COC is associated with

increased hospital admissions and ED visits, even in a health care

system that lacks a referral arrangement framework. This suggests

that improving the COC is beneficial both or patients and good

communication and coordination between primary care.

P-742

Transferring care: improving the safety and quality for patients

moving between hospital and care homes

L. Shaw, C. Norton.

Gateshead Health NHS Foundation Trust / Kings

College London / NHS Health Education England

Approximately 325,000 older people in the UK live in care homes,

experiencing 40

–

50% more emergency hospital admissions than the

general over 75 years old population. Research demonstrates increased

vulnerability to adverse outcomes at touch points between care

settings, with inadequate communication and poor co-ordination

common. A small quality improvement project was undertaken,

within a district general hospital introducing a new Transfer of

Care document. Plan, Do, Study, Act [PDSA] methodology was used.

Several behavioural change interventions were employed, considering

the local context and included audit and feedback, case-based

discussion and championing by local opinion leaders. The overall

aim was that 100% of patients would have transfer information rated

as good or excellent. Demonstrable improvements were measured

in the standard of written information provided at transition of

care: Quality 57%, Accuracy 41%, Completeness 66%. However in 16% of

cases the audited documents were rated as poor with reported

information gaps. Conclusions drawn are that utilising a structured

framework for implementation was essential and PDSA cycle was

an effective tool. Cross boundary aspects emphasized the difficulties of

differing perspectives, priorities and role conflicts and the significant

effect that context has on behavioural change. Equally, variances in

results show that the introduction of a structured document alone is

not guaranteed to positively influence behavioural changes or improve

care quality therefore further refinement of this process is required

with focus on education to raise awareness of the benefits to frail older

patients will be crucial in achieving a consistent and sustainable

improvement.

P-743

Barriers and facilitators for using a new screening tool for older

medical patients in an emergency department in Denmark: a

qualitative study applying the Theoretical Domains Framework

J.W. Kirk

1,2

, D.M. Sivertsen

, J. Petersen

1,3

, P. Nielsen

, H.V. Petersen

Optimed, Clinical Research Centre, Copenhagen University Hospital,

Hvidovre,

Department of Education, Aarhus University, Emdrup,

Section

of Biostatistics, Department of Public Health, University of Copenhagen,

Copenhagen, Denmark,

Division of Community Medicine, Department of

Medical and Health Sciences, Linköping University, Linköping, Sweden

Introduction:

In Denmark more than 35% of older medical patients

acutely admitted to the Emergency Department (ED) are readmitted

within 90 days after discharge. A new screening tool for use in the ED

aiming to identify patients at high risk of functional decline and

readmission was developed. To qualify implementation process, the

aim of this study was to identify factors that were perceived as most

important to facilitate or hinder introduction and intended use of the

new tool in the ED among nurses and a geriatric team.

Methods:

A qualitative study based on semi-structured interviews

and focus groups with nurses, a geriatric team and their leaders. The

Theoretical Domains Framework (TDF) guided data collection and

analysis. Further, a content analysis was performed.

Results:

Six predominant theoretical domains were identified. Within

these six domains three themes emerged, each containing two sub-

themes. These were: (1) professional role and identity (expert culture

and professional boundaries), (2) beliefs about consequences (time and

threat to professional identity) and (3) pre-conditions for a successful

implementation (meaning &making sense and leadership & resources).

Conclusions:

Two different cultures in the ED were identified. These

cultures formed different professional roles and identity, different

actions and sense making, and formed how barriers and facilitators

linked to the new screening tool were perceived. This study shows

that different cultures exist in the same local context and influence

the perception of barriers and facilitators differently. These results

emphasize the importance of understanding the local culture before

any implementation strategy is planned.

P-744

Stress reduction through listening tomusic during gastroscopy and

colonoscopy

N. Sokolowska

, R. Soko

owski

, K. Klimkiewicz

, A. Kwiatkowska

3,4

Department and Clinic of Geriatrics Collegium Medicum in Bydgoszcz,

Nicolaus Copernicus University,

Department of Hygiene, Epidemiology,

and Ergonomics, Department of Ergonomics and Exercise Physiology,

Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University,

Department of Music Therapy, Collegium Medicum in Bydgoszcz,

Nicolaus Copernicus University,

Department of Gastroenterology

Music has been used for centuries to treat certain medical conditions,

especially mental illness and emotional disorders. In the literature

there is the term Anglo-Saxon Music Medicine, where the therapeutic

agent is music. Many authors recommend patients listen to music

before and during the execution of unpleasant for them to research

and treatments for example by endoscopy, where the patient often

feels fear of pain.

Aim:

Analysis of the impact of music on arterial pressure and heart rate

in patients undergoing endoscopy.

Materials and methods: Study was conducted at the Department of

Gastroenterology and Nutrition Disorders Collegium Medicum in

Bydgoszcz, Nicolaus Copernicus University. The study included 90

people aged 19

–

80 years old (55.6% women). The participants have

been subjected to endoscopy: colonoscopy n = 51(57%); gastroscopy

n = 39(43%). The research group (n = 45) was subjected to the interven-

tion of the music but control group (n = 45) was without the inter-

vention of the music. Was conducted the measurement systolic

pressures, diastolic pressure and heart rate before and after the

intervention. Statistical analysis was performed U Mann Whitney

using Statistica 12.5.

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

–

S259

S224