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
, 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,
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
, I. Barat
, M. Gregersen
, E.M. Damsgaard
of Geriatrics, Aarhus University Hospital, Denmark,
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)
, R. McNamara
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
, S. Santos
, C. Faria
, J. Monteiro
, J.R. Monteiro
, F. Pinhal
, 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