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population (271 vs 188 minutes) (p < 0.001). Also, LOS was greater

when priority triage was Orange (418 vs 267 minutes) (p < 0.001).

Priority triage was higher in older patients (p < 0.001). Manchester

triage attributed most patients to General Practice (30.2%), followed

by Internal Medicine (25.3%). However, in the geriatric population

most patients were observed by Internal Medicine while younger

patients were found by General Practice (p < 0.001). Older patients

were more frequently admitted to ward than younger patients

(p < 0.001). Internal medicine is the pivot specialty for assessment of

older patients which presents higher LOS in the ED, require more

immediate attention and required to be admitted in hospital ward

more often. With aging population ED will require being adapted to

their particular needs.


A comparison of patient characteristics and outcomes between

patients admitted to hospital with vertebral fragility fractures and

hip fractures

S. Walters


, T. Ong


, O. Sahota




Department for Healthcare of Older

People, Nottingham University Hospitals NHS Trust, United Kingdom,


Division of Rehabilitation and Ageing, University of Nottingham,

United Kingdom


Orthogeriatric care has been advocated in vertebral

fragility fractures (VFF) management to deliver the same benefits

seen in HF care. Development of such a model needs a robust evidence

base. This study aims to describe patient characteristics and outcomes

of those admitted to hospital with VFF compared with HF patients.


A retrospective study of 30 HF and 24 VF patients admitted

to the trauma unit and spinal unit was conducted. Data was collected

on patient characteristics, admission details and discharge outcomes.


VFF patients were younger [mean(SD) age: 67.7(12.9) vs 84.5

(7.5), p < 0.01]; had lower prevalence of dementia [8% vs 47%, p < 0.01];

had less carer input [5% vs 43%, p < 0.01]; and less likely to have

fallen in the last year [30% vs 50%, p < 0.01]. Otherwise, similar

characteristics were demonstrated between VFF and HF: gender

[female 58% vs 77%, p = 0.15], on

4 medication [67% vs 40%, p = 0.05],

number of co-morbidities [p = 0.26], outdoor mobility [67% vs 50%,

p = 0.26] and use of walking aid [55% vs 60%, p = 0.73]. At 6 months, no

recordedmortality for VFF, but 20% in the HF group. The median length

of stay for VFF was 9 days and 14.5 days for HF (p = 0.04). More hip

fracture patients needed higher carer input upon discharge.


This VFF cohort is not fully representative of hospitalised

VFF patients as the majority of them are managed non-operatively

outside the spinal unit. In this analysis, although HF patients appear

frailer than VF patients, there are similarities between these groups

in terms of co-morbidities, polypharmacy, mobility and vitamin D

deficiency, which provide similar opportunities for optimization of

health status, bone health and prevention of further fractures. Further

work is needed to evaluate the role of orthogeriatric care in VFF

management in hospital.


Comparison of acute older medical patients according to type of


L.H. Pedersen


, I. Barat


, M. Gregersen


, E.M. Damsgaard





of Geriatrics, Aarhus University Hospital, Denmark,


Department of

Medicine, The Regional Hospital in Horsens, Denmark


To examine the length of hospital stay (LOS), number of

readmissions and mortality rate in geriatric patients admitted from

nursing homes compared to patients admitted from their own homes.


A cohort study of all patients 75 years or older acutely

admitted to an emergency department (ED) with one of nine medical

diagnoses: pneumonia, COPD, urinary tract infection, other infections,

delirium, anemia, constipation, dehydration, and heart failure were

included from June 1, 2014 to October 31, 2015. The patients received

Comprehensive Geriatric Care in the ED followed by discharge or

transfer to a geriatric ward.


The study population consisted of 357 nursing home residents

and 971 patients admitted from their own home. In the nursing home

residents, 75% were discharged directly home from the ED (median

LOS: 1 day (IQR: 1

3)). In patients from own homes, 56% were

discharged directly home (median LOS: 5 days (IQR: 1

9) (p < 0.001).

Readmission ratewas 16% in nursing home residents vs.18% in patients

from own homes. When adjusting the risk there was a trend towards

a lower risk of readmission among the nursing home residents, HR-

adjusted = 0.73 (95% CI: 0.52

1.02). Comorbidity was an independent

risk factor. Thirty-day mortality was significantly higher among the

nursing home residents (22% vs. 10%, p < 0.001) HR-adjusted = 1.81

(95% CI: 1.42

2.33). Comorbidity and no walking ability were

independent risk factors.


The hospital admitted nursing home patients differ

from the patients admitted from own homes by shorter LOS and a

trend towards a lower readmission rate. Mortality was highest among

patients admitted from nursing homes, and patients with high

comorbidity and walking disabilities.


Falls prevention: starting at the beginning (QIP)

T. Pervez


, R. McNamara




St Mary

s Hospital, Imperial College

Healthcare NHS Trust, London, UK


In-hospital patient falls is a burning issue with, nearly

240,000 falls reported from acute and community hospitals in England

and Wales every year. Of these, nearly 1400 result in hip and other

fractures. The financial burden of this on the NHS is over £15 million

per year, albeit precise figures of the overall costs are much likely to be

higher due to associated invisible costs.


The Emergency department (ED) patient cohort and

ergonomics profoundly increases the risk of falls in patients in the

department. Furthermore, a significant number of the inpatients begin

their hospital journey at the ED. AIM: To reduce the number, and

subsequent consequences, of in-hospital falls at the front door by

increasing awareness and vigilance; carrying out early assessment and

introducing early fruitful interventions.


A pragmatic quality improvement project (QIP) carried out

by the introduction of simple and cost-effective measures in ED.

The initiative consisted of 2 phases: phase 1

focused on increasing

awareness and phase 2

focused on falls prevention. PDSA approach

was used for project development, progression and assessment.

Careful processing mapping led to clear identification of primary and

secondary drivers, which were then used to identify aims and



Delivered outcomes recorded in the form of stakeholder

satisfaction, reduction in the number of falls and reduction in the

severity of injuries sustained secondary to the number o falls.

Prospective database, questionnaires and structured interviews were

conducted to achieve this.


Increasing awareness and taking measures preventive

measures helped to reduce the number, and impact, of falls in the ED.

The QIP also formed an integral part of the current frailty-friendly

ED project in the Trust. It encouraged awareness and vigilance

across the wider multidisciplinary team, having a holistic impact on

the hospitalized patients. The project also received a positive reaction

on the social media and won second prize at the RSM meeting

(presented in the early stages of the project).


Incidence and outcomes of sepsis in elderly patients admitted to

internal medicine wards

A. Ponciano


, S. Santos


, C. Faria


, J. Monteiro


, J.R. Monteiro


, F. Pinhal



J. Leite


, C. Fernandes




Centro Hospitalar Leiria, Leiria, Portugal


The incidence of sepsis and septic shock is increasing in

older population. However, there is growing evidence that a significant

percentage of these patients is not treated in an intensive care unit.

The aim of this study is to examine sepsis in older adults admitted to

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