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P0218 THE SHORT-STAY UNIT: CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS
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Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
Keywords: glomerular disease proteinuria hyperthyroidism nephrotic syndrome autoimmune thyroiditis focal segmental glomerulosclerosis anti-TPO anti-TG Trab TSH receptor autoantibodies thyroid disorders kidney renal methimazole
P0217 DRIVING ADVICE IN PATIENTS WITH CEREBROVASCULAR DISEASE
Kayvan Khadjooi 1 , Deepak Bhatia 2 , John Paterson 1 . 1 Department of Medicine, Scarborough General Hospital, United Kingdom; 2 Department of Medicine, Hull Royal Infirmary, United Kingdom Background: In the United Kingdom, the Driver and Vehicle Licensing Agency (DVLA) is legally responsible for deciding on medical fitness to drive. It is the duty of the licence holder or licence applicant to notify the DVLA of any medical condition which may affect safe driving and doctors should make sure that patients understand that the condition may impair their ability to drive. Doctors are advised to document formally and clearly in the notes the advice that has been given. Cerebrovascular events are one the common causes of collapse at the wheel. The DVLA has detailed guidelines regarding cerebrovascular disease, including stroke due to occlusive vascular disease, spontaneous intracerebral haemorrhage, TIA and amaurosis fugax. Aim: Our aim was to determine whether appropriate driving advice was given to patients admitted to the Acute Admissions Unit (AAU) with TIA/CVA. Methods: We reviewed the medical notes of patients admitted to AAU at 2 medical centres in the United Kingdom (Hull Royal Infirmary and Scarborough General Hospital) with diagnosis of TIA or CVA in the 12 months period up to June 2008, focusing on the emergency admission and not the follow up. Overall 118 notes were reviewed and 33 were excluded (e.g. long-term disabilities, dependency on carers and death). The DVLA guidelines on cerebrovascular disease were used as standard. Results: Total audit population was 85 with male/female ratio of 1.1:1 with the age range of 35 to 92. In 40 patients (47%) the diagnosis was ischemic stroke, 44 patients (52%) had TIA (2 recurrent TIAs), and 1 patient had intracerebral haemorrhage. 2 patients had their driving status (whether the patient drives or not) documented as part of the social history. Only 5 patients (5.8%) received driving advice, of which 1 was documented both in the notes and in the discharge letter, and in 4 patients it was documented in the notes but not in the discharge letter. 94.2% did not receive advice or if they did, it wasn’t documented. Conclusion: Of the 85 patients admitted with TIA/CVA to 2 medical centres in the United Kingdom, only 5.8% received driving advice and only 1 patient had proper documentation. It is important to note that people in old age still drive, even patients with dementia. This emphasises the need for education of doctors at all levels regarding correct driving advice, the importance of proper documentation and potential legal implications. We recommend giving driving advice leaflets to patients on their discharge from hospital. Reference: www.dvla.gov.uk: At a glance guide to the current medical standards of fitness to drive (for medical practitioners). Keywords: Driving advice, cerebrovascular disease.
the following factors: age, gender, main diagnosis, length of stay, and destination on discharge. We calculated mean values for these factors and defined the main diagnosis using the DRG classification. We adapted the adjusted mean length of stay of our patients to the requirements of the autonomous community of Madrid. SPSS was used for the statistical analysis. Results: A total of 7182 patients were evaluated between 2004 and 2007 (55.9% women, 44.1% men). The mean (SD) age was 67.94 (20.5) years. The mean length of stay was 3.46 days. 76% of patients were sent home on discharge and 19.3% of cases were transferred to other departments. The most frequent main diagnosis was respiratory disease (21.6%), followed by kidney and urinary infections (15.2%), heart failure (15.1%), gastrointestinal infections (4.3%), venous thrombosis (2.3%), and cellulitis (1.5%). The main diagnoses in patients who were transferred to other departments were respiratory disease (27.25%), heart diseases (14.6%), kidney and urinary tract infections (5.8%), and cellulitis (1.5%). The adjusted mean length of stay index during the study period was 0.56.
Respiratory diseases Kidney and urinary infections Heart faillure Gantrointestinal infections Venous thrombosis Cellulitis Others TOTAL
Patients
Percentage (%)
1552 1092 1085 309 165 108 2871 7182
21.6 15.2 15.1 4.3 2.3 1.5 40.0 100
Figure 1. Mean age in patients admitted in the short stay unit.
P0218 THE SHORT-STAY UNIT: CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS
Ana Torres Do Rego, Cristina Díez Romero, Laura Cano Alcalde, Eduardo Oliveros Acebes, Itxasne Cabezón Estevánez, Joanna Szymaniec, Carmen Cuenca Carvajal, María Calderón Moreno, Maria Jesús Granda Martín, Luis Audibert Mena. Hgu Gregorio Marañon Background: The short-stay unit receives patients from the emergency department who are diagnosed with an acute episode and whose stay is expected to be short. These patients are only accepted if they fulfill strict admission criteria (maximum stay of five days and discharge or transfer to a conventional internal medicine unit). Our institution is a tertiary 1700-bed hospital serving a population of 750,000 people, and our short-stay unit depends on the internal medicine department. The team is made up of three senior doctors, three medical residents, and eleven nurses, who are responsible for 22 beds. Objectives: To analyze the clinical and epidemiological characteristics of a short-stay unit and the management of its patients, and to study the most frequent conditions diagnosed. Methods: In this descriptive study, we recruited patients admitted to a 22-bed short-stay unit between 1 January 2004 and 31 December 2007. We analyzed
Figure 2. Destination on discharge.
Conclusions: The short-stay unit can decrease the length of stay, and is an alternative to conventional hospitalization. Therefore, care is better and more cost-efficient. The most important diagnoses in our unit are consistent with the most frequently diagnosed conditions in our population. Keywords: Short-stay unit, length of stay, cost-efficience, adjusted mean length of stay.
Abstracts from 8th Congress of the European Federation of Internal Medicine / European Journal of Internal Medicine 20S (2009), S1–S283
Keywords: glomerular disease proteinuria hyperthyroidism nephrotic syndrome autoimmune thyroiditis focal segmental glomerulosclerosis anti-TPO anti-TG Trab TSH receptor autoantibodies thyroid disorders kidney renal methimazole
P0217 DRIVING ADVICE IN PATIENTS WITH CEREBROVASCULAR DISEASE
Kayvan Khadjooi 1 , Deepak Bhatia 2 , John Paterson 1 . 1 Department of Medicine, Scarborough General Hospital, United Kingdom; 2 Department of Medicine, Hull Royal Infirmary, United Kingdom Background: In the United Kingdom, the Driver and Vehicle Licensing Agency (DVLA) is legally responsible for deciding on medical fitness to drive. It is the duty of the licence holder or licence applicant to notify the DVLA of any medical condition which may affect safe driving and doctors should make sure that patients understand that the condition may impair their ability to drive. Doctors are advised to document formally and clearly in the notes the advice that has been given. Cerebrovascular events are one the common causes of collapse at the wheel. The DVLA has detailed guidelines regarding cerebrovascular disease, including stroke due to occlusive vascular disease, spontaneous intracerebral haemorrhage, TIA and amaurosis fugax. Aim: Our aim was to determine whether appropriate driving advice was given to patients admitted to the Acute Admissions Unit (AAU) with TIA/CVA. Methods: We reviewed the medical notes of patients admitted to AAU at 2 medical centres in the United Kingdom (Hull Royal Infirmary and Scarborough General Hospital) with diagnosis of TIA or CVA in the 12 months period up to June 2008, focusing on the emergency admission and not the follow up. Overall 118 notes were reviewed and 33 were excluded (e.g. long-term disabilities, dependency on carers and death). The DVLA guidelines on cerebrovascular disease were used as standard. Results: Total audit population was 85 with male/female ratio of 1.1:1 with the age range of 35 to 92. In 40 patients (47%) the diagnosis was ischemic stroke, 44 patients (52%) had TIA (2 recurrent TIAs), and 1 patient had intracerebral haemorrhage. 2 patients had their driving status (whether the patient drives or not) documented as part of the social history. Only 5 patients (5.8%) received driving advice, of which 1 was documented both in the notes and in the discharge letter, and in 4 patients it was documented in the notes but not in the discharge letter. 94.2% did not receive advice or if they did, it wasn’t documented. Conclusion: Of the 85 patients admitted with TIA/CVA to 2 medical centres in the United Kingdom, only 5.8% received driving advice and only 1 patient had proper documentation. It is important to note that people in old age still drive, even patients with dementia. This emphasises the need for education of doctors at all levels regarding correct driving advice, the importance of proper documentation and potential legal implications. We recommend giving driving advice leaflets to patients on their discharge from hospital. Reference: www.dvla.gov.uk: At a glance guide to the current medical standards of fitness to drive (for medical practitioners). Keywords: Driving advice, cerebrovascular disease.
the following factors: age, gender, main diagnosis, length of stay, and destination on discharge. We calculated mean values for these factors and defined the main diagnosis using the DRG classification. We adapted the adjusted mean length of stay of our patients to the requirements of the autonomous community of Madrid. SPSS was used for the statistical analysis. Results: A total of 7182 patients were evaluated between 2004 and 2007 (55.9% women, 44.1% men). The mean (SD) age was 67.94 (20.5) years. The mean length of stay was 3.46 days. 76% of patients were sent home on discharge and 19.3% of cases were transferred to other departments. The most frequent main diagnosis was respiratory disease (21.6%), followed by kidney and urinary infections (15.2%), heart failure (15.1%), gastrointestinal infections (4.3%), venous thrombosis (2.3%), and cellulitis (1.5%). The main diagnoses in patients who were transferred to other departments were respiratory disease (27.25%), heart diseases (14.6%), kidney and urinary tract infections (5.8%), and cellulitis (1.5%). The adjusted mean length of stay index during the study period was 0.56.
Respiratory diseases Kidney and urinary infections Heart faillure Gantrointestinal infections Venous thrombosis Cellulitis Others TOTAL
Patients
Percentage (%)
1552 1092 1085 309 165 108 2871 7182
21.6 15.2 15.1 4.3 2.3 1.5 40.0 100
Figure 1. Mean age in patients admitted in the short stay unit.
P0218 THE SHORT-STAY UNIT: CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS
Ana Torres Do Rego, Cristina Díez Romero, Laura Cano Alcalde, Eduardo Oliveros Acebes, Itxasne Cabezón Estevánez, Joanna Szymaniec, Carmen Cuenca Carvajal, María Calderón Moreno, Maria Jesús Granda Martín, Luis Audibert Mena. Hgu Gregorio Marañon Background: The short-stay unit receives patients from the emergency department who are diagnosed with an acute episode and whose stay is expected to be short. These patients are only accepted if they fulfill strict admission criteria (maximum stay of five days and discharge or transfer to a conventional internal medicine unit). Our institution is a tertiary 1700-bed hospital serving a population of 750,000 people, and our short-stay unit depends on the internal medicine department. The team is made up of three senior doctors, three medical residents, and eleven nurses, who are responsible for 22 beds. Objectives: To analyze the clinical and epidemiological characteristics of a short-stay unit and the management of its patients, and to study the most frequent conditions diagnosed. Methods: In this descriptive study, we recruited patients admitted to a 22-bed short-stay unit between 1 January 2004 and 31 December 2007. We analyzed
Figure 2. Destination on discharge.
Conclusions: The short-stay unit can decrease the length of stay, and is an alternative to conventional hospitalization. Therefore, care is better and more cost-efficient. The most important diagnoses in our unit are consistent with the most frequently diagnosed conditions in our population. Keywords: Short-stay unit, length of stay, cost-efficience, adjusted mean length of stay.