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

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(OutRef). Systemic inflammation was assessed by concentrations of
IL-6, TNFα and suPAR. Associations were investigated by multiple
regression analyses, adjusted for age, sex, cognitive impairment, and
severity of acute illness, estimated by CRP and VitalPAC Modified Early
Warning Score (ViEWS).
Results: The cohort included 369 patients with a median age of 77.9
years. In adjusted analyses, IL-6 was associated handgrip strength
(p = 0.007); TNFα with DEMMI (p < 0.001) and handgrip strength
(p = 0.004), and suPAR with all physical performance measurements
(p < 0.001). All three inflammation markers were associated with
OutRef (p < 0.001). OutRef was associated with all physical perform-
ance measurements (p < 0.001) in analyses adjusted for age, sex,
cognitive impairment and ViEWS.
Conclusion: Systemic inflammation seems to be mediating both organ
dysfunction and low physical performance in acutely admitted older
medical patients and thus could be a clinical feasible modality for
systematically assessment of vulnerability in this population.
P-036
Do we follow the national and international guidelines on
thromboprophylaxis in patients with atrial fibrilation
D. Kondova, R. Damani, K. Musarrat. Department of Geriatric Medicine,
University Hospitals of Leicester NHS Trust, UK
Atrial fibrillation (AF) is the most common sustained heart rhythm
disturbance in the UK. With the ageing population the prevalence of
AF is anticipated to double by 2050. The current statistics are that one
of six ischemic strokes is associated with atrial fibrillation. Stroke
directly attributed to AF can have a devastating consequences. Up to
50% of people who have a stroke related to AF die within one year. AF
related stroke is preventable, but many patients currently do not
receive optimal prevention therapy.
Objectives: To identify the percentage of patients with AF admitted in
our hospital who were anticoagulated. To find if hospital doctors
considered thromboprophylaxis in patients with AF who are eligible as
per National and European guidelines. To find out if there is enough
documentation in the patients records in support decisions for or
against anticoagulation.
Methods: This was a prospective audit. We audited the notes of all
surgical and medical patients admitted in our hospital at the time.
Results: The notes of 450 patients were reviewed. Of those there were
50 patients with AF.96% were at an age of above 65. All patients
had CHADS-VASc score of 2 and above but only 40% of the admitted
patients were anticoagulated. 50% from the rest were on antiplatelet.
Only 22% of patients with AF who were not anticoagulated had a
plan for thromboprophylaxis documented. There was no evidence of
calculation of CHADS-VASc score. Only in 30% of those not antic-
oagulated the reason for omission of anticoagulationwas documented.
P-037
Improvingmultidisciplinary teammeetings in geriatric emergency
medicine
S. Kumar 1, M. Ren1, T. Morris1, A. Kaval 1, S. Madi1, A. Matin1, S. Turpin1.
1University Hospitals of Leicester, United Kingdom
Introduction: Multidisciplinary team (MDT) communication is key to
providing comprehensive geriatric assessment. Leicester ’s Emergency
Frailty Unit (EFU) aims to deliver two brief MDT meetings per day to
aid communication and efficient patient assessment and manage-
ment. Historical meeting attendance rates were variable. A quality
improvement (QI) project was designed to optimise the frequency
and attendance at meetings, aiming to improve communication and
reduce variability.
Methods: Quality improvement methodology was used (PDSA cycles).
Baseline data collection was continuous during this period and
included the number of handovers per day, attendance of MDT
members and length of meeting. Two planned interventions occurred:
1. MDTmeeting rates and attendancewere published and an email was
sent to all MDT members explaining the rationale for the project
(Intervention 1). 2. All teammembers were encouraged to take shared
ownership and initiation of the MDT meetings (Intervention 2).
Results: Both interventions resulted in a measurable improvement in
the frequency and attendance of MDT meetings.
• Occurrence of an MDT on any given day improved from 25% to
100%.
• Proportion of MDT present during a meeting improved from 25% to
70%.
• Length of meetings decreased from 88.7 seconds to 79.1 seconds
per patient.
Key conclusions: Using established QI methodology, this project has
identified that the frequency and attendance of rapid MDT meetings
in an emergency medicine setting can be improved with no adverse
impact on the duration of the meeting.
P-038
Hospital acquired urinary tract infections in a community hospital
Y. Latief1, C. Lisk 2. 1Potters Bar Hospital, Hertfordshire Community NHS
Trust, 2Barnet Hospital, Royal Free NHS Foundation Trust
Introduction: Hospitalised patients are predisposed to a variety of
nosocomial infections; these may include multidrug resistance
organisms. Since initial treatment is empirical, prior knowledge of
bacterial prevalence as well as resistant patterns in healthcare settings
is essential. The aim of the study was to determine the local prevalence
of bacterial strains and the antibiotic sensitivity of nosocomial
acquired urinary tract infections in a 29 bedded rehabilitation unit
for older adults in order to guide empirical antibiotic choice when
antibiotic sensitivities are still unknown in the first 48 hours of
treatment.
Methods: We analysed the data of all patients with positive urine
culture defined as more than 100,000 bacteria per ml following 48 hrs
of admission to the community hospital.
Results: 53 patients with urinary tract infections were identified. 62%
(33) were aged 81–90 years with a female preponderance 66%(35).
Gram negative bacteria were the cause in the majority of cases with
Escherichia Coli 60% (32/53), Klebsiella Pneumoniae 17% (9/53),
Pseudomonas 9% (5/53) and Proteus 6% (3/53) being the commonest
pathogens. Extended Spectrum Beta-Lactamases (ESBL) accounted
for 5 cases of Escherichia Coli urinary tract infections with sensitivities
to Nitrofurantoin (3), Gentamicin (1), Fosfomicin (1) and Ertapenem
(1). Most bacteria were sensitive to Nitrofurantoin 49% (26/53),
Trimethoprim 25% (13/53) and Gentamicin 15% (8/53). There was
low sensitivity to cephalexin and amoxicillin.
Conclusions: This study suggests that the best antibiotic to start
empiric treatment of nosocomial urinary tract infections is
Nitrofurantoin which is in line with our hospital antibiotic guidelines.
P-039
Defensive medicine and the impact on senior population
I. Sandu1, N. Lefter1, A. Rusu1, I.D. Alexa2, G.I. Prada3, A.I. Pâslaru2.
1“Dr. C.I. Parhon’ Hospital, Iaşi, 2Department of Internal Medicine,
University of Medicine and Pharmacy ‘ Grigore T. Popa’ , Iaşi, 3Department
of Geriatry and Gerontology, University of Medicine and Pharmacy ‘Carol
Davila’, Bucuresti
Introduction: Defensive medicine is an increasing phenomenon in
the medical practice due to physicians’ need to reduce or prevent
complains or criticism by patients or their families. However,
performing defensive medicine in senior population will increase
the risk of exposing the patient to multiple interdisciplinary consults,
aggressive investigations, and poly-medication with disastrous iatro-
genic results.
Case presentation: We report the case of a 72 years old male patient
from rural area who was brought to the emergency room by
ambulance for respiratory and digestive symptoms. As there were no
life-threatening symptoms, he had to wait for six hours before being
seen by a physician. Due to the digestive symptoms, an ultrasound was
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S38