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P-006: The effectiveness of comprehensive geriatric assessment-based intervention reducing frequent emergency department visits in a tertiary medical center in Southern Taiwan
Poster presentations / European Geriatric Medicine 6S1 (2015) S32–S156
P-004 Urinary tract infection versus asymptomatic bacteriuria: an audit on an important clinical dilemma V. Carone1 , M. Kenchaiah2 , A. Bentley2 1 Northampton General Hospital NHS Trust, Nottingham, United Kingdom; 2 Northampton General Hospital NHS Trust, Northampton, United Kingdom Objectives: Urinary tract infection (UTI) is common in the elderly, and it is important to appropriately diagnose and treat it. However, in view of the alarming increase in antibiotic resistance, it is crucial to differentiate true UTI from asymptomatic bacteriuria (AB), which is also common in the elderly but should not be treated. The objective of this retrospective audit was to evaluate whether the screening for UTI (using dipsticks) in a district general hospital adhered to the international guidelines, in particular in elderly patients. Methods: 100 clinical notes of patients of both sexes, aged ≥18 years, admitted to the acute medical take in November and December 2014, were randomly selected. Data were collected and analysed to find common patterns of screening and diagnosis of UTI versus AB. The majority of the sampled population was aged ≥65 (74%). Data were compared to the standards set by the European Association of Urology. Results: Screening for UTI was inappropriately performed in 56.6% of patients aged ≥65, and in 75% of them AB was misdiagnosed and treated as UTI. No unifying criteria were found in the way screening was performed and its results interpreted by clinicians. Conclusions: Screening for UTI was substandard and AB was too often treated as UTI, leading to inappropriate use of antibiotics, especially in the elderly. A clinical staff education programme is proposed in order to raise awareness of the difference between AB and UTI and reduce the risks of antibiotic resistance and opportunistic infections such as Clostridium difficile. P-005 The application of team resource management for effective multidisciplinary team working in the emergency department in a community hospital in Southern Taiwan S.-L. Chou1 , M.-Y. Chou2 , C.-Y. Chang3 , F.-Y. Chen4 , B.-C. Yuan5 , M.-S. Chang6 1 Division of Emergency Medicine, Fooyin University Hospital, Pintung, Taiwan; 2 Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 3 Department of Nursing, Fooyin University Hospital, Pintung, Taiwan; 4 Department of Medicine, Fooyin University Hospital, Pintung, Taiwan; 5 Division of Otolaryngology, Fooying University Hospital, Pintung, Taiwan; 6 Division of Surgery, Fooyin University Hospital, Pintung, Taiwan Objectives: Patient safety in an important issue in the emergency department (ED), especially facing the growing ageing population with complex conditions. The purpose of this study was to evaluate the effectiveness of the application of team resource management (TRM) in ED. Methods: The implements of TRM were applied in the ED of FooYin University Hospital, a community hospital in southern Taiwan. The workshop and standard lectures on organizational/leadership skills, team solidarity, communication and teamwork were given for all staffs since 2011. The instructor taught different strategies and tools monthly to promote the effective multidisciplinary team working environment. Safety Attitudes Questionnaire based on 2008 Medical Design III Hospital Patient Safety Attitude Scale from Taiwan Joint commission on Hospital Accreditation were used for all ED staffs before and after TRM training program. Results: There are 4 physicians and 16 nurses completing the TRM training program. The results of six categories of Safety Attitudes Questionnaire improved after the TRM training program, including teamwork climate (33.3% to 66.7%), safety climate (31.8% to 77.8%),
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job satisfaction (31.8% to 77.8%), stress recognition (63.6% to 72.2%), perception of management (18.2% to 44.4%) and working condition (25.0% to 55.6%). Moreover, the annual quitting rate of nurses decreased from 33.3% to 12.5%, and the rate of positive feedback from patients increased from 2.6% to 57.1%. Conclusions: The Application of TRM in ED could improve the effectiveness of multidisciplinary team working and patient safety. Facing the growing ageing population, further study is needed to confirm the effectiveness of TRM in ED. P-006 The effectiveness of comprehensive geriatric assessment-based intervention reducing frequent emergency department visits in a tertiary medical center in Southern Taiwan M.-Y. Chou1 , S.-L. Chou2 , C.-K. Liang3 , M.-C. Liao1 , K.-C. Hsueh4 , Y.-T. Lin1 , H.-C. Lam5 1 Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 2 Division of Emergency Medicine, Fooyin University Hospital, Pintung, Taiwan; 3 Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; 4 Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 5 Kkaohsiung Veterans General hospital, Kaohsiung, Taiwan Objectives: The purpose of this study was to evaluate the effectiveness of comprehensive geriatric assessment (CGA)-based intervention for emergency department (ED) frequent visitors. Methods: From January to November 2013, older people visiting the ED of Kaohsiung Veterans General Hospital for three times within 30 days were recruited for study. Those with critical condition or pass away in ED, cancer in terminal stage or NG tube dislocation were excluded. The staffs in ED would evaluate those frequent ED visits first and consult our geriatric team for performing CGA and geriatric intervention. Number of ED visits, admission time and death in 1, 6 and 12 months were recorded for comparison. Results: Overall, 137 frequent ED visitors (mean age 80.3±7.2 years, 73.7% males) were enrolled for study, and 26 (19.0%) were treated with CGA-based intervention. There were no significant difference between geriatric intervention and nongeriatric intervention groups for age, gender, triage and tentative diagnosis. Comparing with non-geriatric intervention group, those with geriatric intervention would more likely to be admitted (50.0% versus 21.6%, p = 0.003) in ED, to visit ED for less times within 1 month (0.81±0.85 versus 1.75±1.16, p < 0.001) and within 6 months (2.23±2.56 versus 3.97±3.17, p = 0.010). Conclusions: For frequent ED visitors, the CGAt-based Intervention could reduce the times of ED visits within 1 and 6 months significantly. Further randomized control trial with standard inclusion/exclusion criteria is needed to confirm the effectiveness of CGA-Based Intervention among frequent ED visitors. P-007 Massive hematemesis due to fistula between an artery of the intrathoracic goiter and the middle esophagus in an elderly patient Y.R. Davila Barboza1 , E.H. Azana Fernandez1 1 Hospital San Juan de Dios, Le´ on, Spain Introduction: Relatively few case reports have been published on bleeding due to fistula in relation to thyroid pathology. Method: Literature review and patient clinical documentation Results: An 81 year-old-man was admitted to the Geriatric Deparment because of pneumonia. She had a history of hypertension, recurrent goiter after a subtotal thyroidectomy in 1979 for multinodular goiter, chronic renal failure. Treatment: Levothyroxine, furosemide,omeprazole, amlodipine. During hospitalization presents hematemesis, she received transfusion of packed red cells and underwent a gastroscopy
P-004 Urinary tract infection versus asymptomatic bacteriuria: an audit on an important clinical dilemma V. Carone1 , M. Kenchaiah2 , A. Bentley2 1 Northampton General Hospital NHS Trust, Nottingham, United Kingdom; 2 Northampton General Hospital NHS Trust, Northampton, United Kingdom Objectives: Urinary tract infection (UTI) is common in the elderly, and it is important to appropriately diagnose and treat it. However, in view of the alarming increase in antibiotic resistance, it is crucial to differentiate true UTI from asymptomatic bacteriuria (AB), which is also common in the elderly but should not be treated. The objective of this retrospective audit was to evaluate whether the screening for UTI (using dipsticks) in a district general hospital adhered to the international guidelines, in particular in elderly patients. Methods: 100 clinical notes of patients of both sexes, aged ≥18 years, admitted to the acute medical take in November and December 2014, were randomly selected. Data were collected and analysed to find common patterns of screening and diagnosis of UTI versus AB. The majority of the sampled population was aged ≥65 (74%). Data were compared to the standards set by the European Association of Urology. Results: Screening for UTI was inappropriately performed in 56.6% of patients aged ≥65, and in 75% of them AB was misdiagnosed and treated as UTI. No unifying criteria were found in the way screening was performed and its results interpreted by clinicians. Conclusions: Screening for UTI was substandard and AB was too often treated as UTI, leading to inappropriate use of antibiotics, especially in the elderly. A clinical staff education programme is proposed in order to raise awareness of the difference between AB and UTI and reduce the risks of antibiotic resistance and opportunistic infections such as Clostridium difficile. P-005 The application of team resource management for effective multidisciplinary team working in the emergency department in a community hospital in Southern Taiwan S.-L. Chou1 , M.-Y. Chou2 , C.-Y. Chang3 , F.-Y. Chen4 , B.-C. Yuan5 , M.-S. Chang6 1 Division of Emergency Medicine, Fooyin University Hospital, Pintung, Taiwan; 2 Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 3 Department of Nursing, Fooyin University Hospital, Pintung, Taiwan; 4 Department of Medicine, Fooyin University Hospital, Pintung, Taiwan; 5 Division of Otolaryngology, Fooying University Hospital, Pintung, Taiwan; 6 Division of Surgery, Fooyin University Hospital, Pintung, Taiwan Objectives: Patient safety in an important issue in the emergency department (ED), especially facing the growing ageing population with complex conditions. The purpose of this study was to evaluate the effectiveness of the application of team resource management (TRM) in ED. Methods: The implements of TRM were applied in the ED of FooYin University Hospital, a community hospital in southern Taiwan. The workshop and standard lectures on organizational/leadership skills, team solidarity, communication and teamwork were given for all staffs since 2011. The instructor taught different strategies and tools monthly to promote the effective multidisciplinary team working environment. Safety Attitudes Questionnaire based on 2008 Medical Design III Hospital Patient Safety Attitude Scale from Taiwan Joint commission on Hospital Accreditation were used for all ED staffs before and after TRM training program. Results: There are 4 physicians and 16 nurses completing the TRM training program. The results of six categories of Safety Attitudes Questionnaire improved after the TRM training program, including teamwork climate (33.3% to 66.7%), safety climate (31.8% to 77.8%),
S33
job satisfaction (31.8% to 77.8%), stress recognition (63.6% to 72.2%), perception of management (18.2% to 44.4%) and working condition (25.0% to 55.6%). Moreover, the annual quitting rate of nurses decreased from 33.3% to 12.5%, and the rate of positive feedback from patients increased from 2.6% to 57.1%. Conclusions: The Application of TRM in ED could improve the effectiveness of multidisciplinary team working and patient safety. Facing the growing ageing population, further study is needed to confirm the effectiveness of TRM in ED. P-006 The effectiveness of comprehensive geriatric assessment-based intervention reducing frequent emergency department visits in a tertiary medical center in Southern Taiwan M.-Y. Chou1 , S.-L. Chou2 , C.-K. Liang3 , M.-C. Liao1 , K.-C. Hsueh4 , Y.-T. Lin1 , H.-C. Lam5 1 Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 2 Division of Emergency Medicine, Fooyin University Hospital, Pintung, Taiwan; 3 Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan; 4 Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 5 Kkaohsiung Veterans General hospital, Kaohsiung, Taiwan Objectives: The purpose of this study was to evaluate the effectiveness of comprehensive geriatric assessment (CGA)-based intervention for emergency department (ED) frequent visitors. Methods: From January to November 2013, older people visiting the ED of Kaohsiung Veterans General Hospital for three times within 30 days were recruited for study. Those with critical condition or pass away in ED, cancer in terminal stage or NG tube dislocation were excluded. The staffs in ED would evaluate those frequent ED visits first and consult our geriatric team for performing CGA and geriatric intervention. Number of ED visits, admission time and death in 1, 6 and 12 months were recorded for comparison. Results: Overall, 137 frequent ED visitors (mean age 80.3±7.2 years, 73.7% males) were enrolled for study, and 26 (19.0%) were treated with CGA-based intervention. There were no significant difference between geriatric intervention and nongeriatric intervention groups for age, gender, triage and tentative diagnosis. Comparing with non-geriatric intervention group, those with geriatric intervention would more likely to be admitted (50.0% versus 21.6%, p = 0.003) in ED, to visit ED for less times within 1 month (0.81±0.85 versus 1.75±1.16, p < 0.001) and within 6 months (2.23±2.56 versus 3.97±3.17, p = 0.010). Conclusions: For frequent ED visitors, the CGAt-based Intervention could reduce the times of ED visits within 1 and 6 months significantly. Further randomized control trial with standard inclusion/exclusion criteria is needed to confirm the effectiveness of CGA-Based Intervention among frequent ED visitors. P-007 Massive hematemesis due to fistula between an artery of the intrathoracic goiter and the middle esophagus in an elderly patient Y.R. Davila Barboza1 , E.H. Azana Fernandez1 1 Hospital San Juan de Dios, Le´ on, Spain Introduction: Relatively few case reports have been published on bleeding due to fistula in relation to thyroid pathology. Method: Literature review and patient clinical documentation Results: An 81 year-old-man was admitted to the Geriatric Deparment because of pneumonia. She had a history of hypertension, recurrent goiter after a subtotal thyroidectomy in 1979 for multinodular goiter, chronic renal failure. Treatment: Levothyroxine, furosemide,omeprazole, amlodipine. During hospitalization presents hematemesis, she received transfusion of packed red cells and underwent a gastroscopy