47 / 290
Results:
173 cases identified. Median age 87 (92
–
82) years old, 74.4%
female, Clinical Frailty Scale 6 (6
–
4), Cumulative Illness Rating Scale-
Geriatrics 10 (14
–
6), 55.6% living alone. 51.1% of patients presented
with falls. Although Glasgow Admission Prediction Score anticipated
hospitalisation in 78.7% of cases, only half of these were admitted,
and in total 56.6% were discharged home. Furthermore, prospective
monitoring showed that 52.2% remained at home 7 days after
discharge and 41.7% at 28 days. Patients requiring admission had
more polypharmacy (p = .038) and higher risk of pressure ulcers
(p = .008). Mortality was extremely low (1.7%) and occurred in the first
7 days of admission.
Conclusions:
This study shows that it is possible to deliver CGA to frail
elderly patients attending a busy ED. Despite patient complexity,
frailty severity, and social context, this intervention managed to
decrease by half predicted hospital admission and may have con-
tributed to reduce attendance. Patients requiring admission are not
significantly different from their counterparts, which reiterates that
care provision in EDs should remain patient-centered.
P-048
Geriatric consultation project in Austrian provincial nursing
homes
P. Mrak
1
, F. Hasandic
2
, P. Krippl
2
, W. Habacher
3
, T. Augustin
3
,
W. Lerchbacher
4
, B. Zirm
4
, M. Siebolds
5
.
1
LKH-Voitsberg, Voitsberg,
2
LKH-Feldbach-Fürstenfeld, Fürstenfeld,
3
Joanneum Research-Health/
EPIG, Graz,
4
LKH-LPZ Radkersburg, Bad Radkersburg, Austria;
5
Katholische Hochschule, Köln, Deutschland
Objectives:
Nursing Home (NH) residents experience a high number
of transfers from nursing facilities to the hospital, many of them
unnecessary, sometimes harmful and always costly. The implementa-
tion of geriatric expertise and counseling in a Provincial Nursing Home
(LPZ) was intended to avoid unnecessary transportation and thus
prevent transfer trauma in terms of physical and emotional stress to
the highly vulnerable residents.
Methods:
In 2014 we performed a controlled, prospective obser-
vational Study over a 6 month period comparing the two preceeding
years and evaluating the effects of structured knowledge transfer
and implementation of geriatric expertise, comprehensive geria-
tric assessement (CGA), geriatric counseling to practitioners and
hospitalists as well as nursing home staff in the LPZ versus care as
usual.
82 nursing home residents(LPZ) were included for intervention,
medium age 81.7 ± 11.7; CGA: Barthel index (ADL) 36,1 ± 29.1;
Esslinger Transfer scale 2.2 ± 1.8; MNA (shortform) 10.5 ± 2.6.
We used the Geriatric Case Conference-Method (PFK) for geriatric
knowledge transfer in periodic sessions during the study period.
Results:
We saw a clear reduction in the number of transports to the
hospital (7.9, 9.2 vs 5.4/pat./y) and less outpatient contacts (299.2,
373.0 vs 198,9/per 100 pat/y) of NH residents in the interventional
LPZ compared to the 2 years ahead. On the contrary admissions to
the hospital (70.8, 68,4 vs 97,8 per 100 pat/y) have risen during
intervention. Satisfaction among caregivers- doctors and nurses did
clearly improve.
Conclusion:
Bilateral Knowledge transfer (PFK) and structured imple-
mentation of geriatric expertise (CGA, Counseling) in nursinghomes
and between all multidisciplinary caregivers involved, can reduce
avoidable transportation trauma to residents and thus improve quality,
continuity and satisfaction of care.
P-049
Multidisciplinary management for multifactorial falls: a quality
improvement project in assessment for geriatric patients
presenting with fall to the emergency department
E. Nally, A. Frater, S. Saber, R. Mizoguchi.
Royal Free London NHS
Foundation Trust, United Kingdom
Introduction:
Falls are one of the commonest causes for geriatric
patients to present to the emergency department (ED). TREAT
(Triage Rapid Elderly Assessment Team) is a specialised geriatric
service which aims to assess and manage patients within the ED
thereby facilitating safe discharge. We aim to identify if guideline
care is being met and to seek alternative approaches to overcome
the challenges faced in assessing falls patients within the emer-
gency setting.
Methods:
We identified 27 patients aged over 80 from the TREAT
database, who presented two or more times with a fall-related
complaint to ED within 6 months. A standard for assessment was
identified from the NICE guidelines and British Geriatrics Society
(BGS) Silverbook.
Results:
As stated in NICE guidelines and BGS Silverbook, we focused
on various aspects as below. 27 patients presented 59 times within a 6
month period. Of 59 presentations, 15% (n = 9) had no witness history
and 54% (n = 32) had no recorded postural blood pressure. On the other
hand 100% (n = 59) had bloods tests, 97% (n = 57) had an electro-
cardiogram (ECG), 93% (n = 55) had a documented abbreviated mini
mental test score (AMTS). 52% (n = 14) had a 24-hour ECG and
echocardiogram within 1 year.
Conclusions:
In summary some of the recommended basic assess-
ments were not performed. On the contrary, despite investigation
patients with falls still presented to ED repetitively. We recognise the
requirement of a proforma available to the multidisciplinary team to
allow a multifactorial assessment within the ED.
P-050
National benchmarking figures of inpatient falls per 1,000
occupied bed days (OBDs) in England and Wales
R. Schoo
1
, N. Vasilakis
1
, R. Stanley
1
, F. Martin
1
, S. Rai
1
, S. O
’
Riordan
1
.
1
Royal College of Physicians (RCP), London, United Kingdom
Introduction:
Falls in hospital are the most commonly reported
patient safety incidents. They can result in serious injuries, slower
recovery and increased costs.
Methods:
The National Audit of Inpatient Falls (NAIF) collected
hospital reported rates of falls and falls that caused injuries during
2014.
Numbers of falls were converted to falls per 1000 OBDs and falls
resulting in moderate harm, severe harm or death per 1000 OBDs.
Results:
For the first time we have the falls rates across both countries,
with 96% of eligible hospital trusts participating.
•
Falls per 1,000 OBDs:
○
mean: 6.52
○
range: 3.11
–
12.52
○
interquartile range (IQR): 5.48
–
7.73
•
Falls resulting in moderate harm, severe harm or death per 1,000
OBDs:
○
mean: 0.18
○
range: 0.03
–
0.58
○
IQR: 0.11
–
0.21
Key Conclusions:
Trusts can now, for the first time, benchmark against
national averages.
Some limitations on the ability to benchmark are:
•
Trust composition: some trusts include only acute hospitals, while
others combine acute hospitals, community hospitals and mental
health units.
•
Patient demographics: rates of falls will be affected by differences
associated with patient casemix. A higher falls rate may indicate
more vulnerable patients. Length of stay may also influence falls
rates.
•
Reporting practices: A higher reported falls rate may indicate
better reporting practices. Very low rates may indicate a poor
culture of defining or reporting falls. For this reason falls result-
ing in moderate harm, severe harm or death were also cal-
culated as falls resulting in injury are more likely to be accurately
reported.
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S41