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P399: Decrease in the number of Accidents and Emergencies unit (A&E) visits by the nursing home population after the introduction of domiciliary care
Poster presentations, Friday 19 September 2014 / European Geriatric Medicine 5S1 (2014) S159–S234
We used multiple logistic regression analysis of baseline frailty indicators and risk factors for delirium. Secondly, we examined prevalent and incident delirium in included and excluded patients. Results: Excluded patients (n = 77) were older, were more frail, had more risk factors for delirium and frailty, and more often had delirium at admission than the included group (n = 115). Independent predictors for exclusion were low MMSE, high IQCODE, poor vision and polypharmacy. Conclusion: This is one of few studies testing different risk factors for excluding elderly patients from an RCT. Inability to give informed consent was an a priori risk factor, but also other frailty indicators independently raised the risk of exclusion. Findings suggest that taurine was tested in a group of patients that may not be representative of the geriatric hospital population. P399 Decrease in the number of Accidents and Emergencies unit (A&E) visits by the nursing home population after the introduction of domiciliary care
S207
fracture (according to the International Classification of Diseases, ninth revision) between 2000 and 2009. Multinomial regression analyses were performed with 2000 as a reference year. Results were adjusted for sex, age, cultural background, living situation before admission and length of hospital stay. Results: The risk of dying 30-day post-discharge relative to dying in hospital increased in 2009 compared to 2000, especially for stroke (OR4.02;CI 3.51–4.61) and MI (OR2.25;CI1.89–2.68). Smallest OR was found for COPD (OR 1.68; CI 1.39–2.04). The risk of survival relative to dying in hospital increased in 2009 compared to 2000, which indicates a decreased risk of dying in hospital versus survival (stroke: OR2.94;CI2.76–3.13 and MI: OR 3.08; CI 2.81–3.38). Conclusion: This study shows an increased 30-day post-discharge mortality between 2000 and 2009, while in-hospital mortality declined. Therefore there is a need for interventions decreasing post-discharge mortality. P401 Do your patients know who you are?
M. Mozos Mutuam, Spain
F. Ehsanullah, R.L. Chu, J.T. Healy, D. Morganstein Chelsea and Westminster Hospital, London, United Kingdom
Introduction: The urgent medical attention to geriatric population in nursing homes has been historically delivered in the A&E unit of the Central Regional Hospital (CRH). Since May 2013, we have introduced a new system of advanced domiciliary care for nursing homes from 8am to 8pm, formed of a physician and a nurse. We analyse the impact of this service on the number of visits to the A&E unit. Methods: We analysed the data available from May 2012 to February 2013 and compared it to the data available from May 2013 to February 2014. We analysed the number of elderly people who attended A&E unit, the date and time of arrival, and discharge. The data was provided by the CRH. Results: In the period from May 2012 to February 2013, the number of residents visiting the A&E unit were 1450 (Monthly average: 145; SD: 9.18). Since the introduction of advanced domiciliary care, in May 2013, the number of residents attended was 1246 (monthly average: 124.6; SD: 11.1). The number of residents who visited A&E unit decreased by 16.10% (p < 0.001), a reduction of 203 visits, compared to the period from May 2012 to February 2013. Conclusions: Advanced domiciliary care decreases the number of patients visiting the A&E unit. Our results are preliminary, since the new system is in its initial phase. The effectiveness of the advanced domiciliary care should be reevaluated to confirm these promising results.
Introduction: The GMC’s Good Medical Practice states that doctors must ensure that all patients “understand [the doctor’s] role and responsibilities in the team, and who is responsible for each aspect of patient care”. We assessed what proportion of medical patients knew the name of their consultant, junior doctor and ward. Methods: All inpatients on general medical wards were surveyed over a week in a busy teaching hospital. Patients had undergone at least one consultant ward round. Exclusion criteria were: elective admissions, patients with an Abbreviated Mental Test Score below 7 and patients on the Acute Assessment Unit due to brevity of stay and transferring of care between doctors. Medical notes were reviewed to identify which doctors were caring for each patient. Results: Of a total of 88 inpatients identified, 46 met inclusion criteria. The mean age of patients surveyed was 74. 43% (n = 20) knew their consultant’s name, 15% (n = 7) knew the name of any of their junior doctors, and 41% (n = 19) knew their ward. Patients under 65 years were more likely to know their consultants name compared with those over 65 years (73% vs 34%, p = 0.037). Conclusions: Our study highlighted a striking lack of knowledge amongst patients regarding who their doctors were and their hospital location. Interestingly, older patients were less likely to know their consultant’s name which may contribute to disorientation when in hospital. We recommend that patients are given this information in a written form upon admission. This could improve accountability and also consolidate the doctor-patient relationship.
P400 Trends in in-hospital mortality and 30-day post-discharge mortality in acutely admitted older patients between 2000 and 2009 in the Netherlands M. van Rijn, B.M. Buurman, J.L. Macneil-Vroomen, E.P. Moll van Charante, S.E. de Rooij Academic Medical Center, Amsterdam, The Netherlands Introduction: Acutely hospitalized patients show high rates of inhospital mortality and 30-day post-discharge mortality. Over the past 10 years, in-hospital mortality has decreased for most diseases. However, it is unknown whether in-hospital mortality and 30day post-discharge mortality, in acutely hospitalized older patients decreased. Therefore, the aim of this study is to investigate trends in in-hospital mortality and 30-day post-discharge mortality for the six most prevalent acute diagnoses in patients 65 years and older. Methods: Retrospective data analyses were conducted for 263,746 patients aged 65 years and older who where acutely admitted for myocardial infarction (MI), heart failure (HF), stroke, chronic obstructive pulmonary disease (COPD), pneumonia and femur
P402 Readmissions after discharge from an acute geriatric unit; an analysis of probable causes A.H. Ranhoff, S. Alaburic, T. Engstad, L.K. Mensen, T. Svendsen Diakonhjemmet Hospital, Oslo, Norway Background: Readmissions after acute hospitalization in medical departments are frequent and often used as a quality indicator. Geriatric patients are at high risk for readmissions. The aim was to find characteristics of patients who had been readmitted after discharge from an acute geriatric ward. In 2012 the Coordination reform was implemented with intention to earlier discharge from hospital to primary care. Material and Methods: A retrospective observation study, using patient administrative data and medical record information from January-June in 2011 and 2013. Data about admissions and within30-days readmissions including primary diagnoses were obtained. Results: In January-June 2011, length of stay (LOS) was 8.2 days (mean), median 5.3, and 46 of 448 (10.2%) patients were readmitted.
We used multiple logistic regression analysis of baseline frailty indicators and risk factors for delirium. Secondly, we examined prevalent and incident delirium in included and excluded patients. Results: Excluded patients (n = 77) were older, were more frail, had more risk factors for delirium and frailty, and more often had delirium at admission than the included group (n = 115). Independent predictors for exclusion were low MMSE, high IQCODE, poor vision and polypharmacy. Conclusion: This is one of few studies testing different risk factors for excluding elderly patients from an RCT. Inability to give informed consent was an a priori risk factor, but also other frailty indicators independently raised the risk of exclusion. Findings suggest that taurine was tested in a group of patients that may not be representative of the geriatric hospital population. P399 Decrease in the number of Accidents and Emergencies unit (A&E) visits by the nursing home population after the introduction of domiciliary care
S207
fracture (according to the International Classification of Diseases, ninth revision) between 2000 and 2009. Multinomial regression analyses were performed with 2000 as a reference year. Results were adjusted for sex, age, cultural background, living situation before admission and length of hospital stay. Results: The risk of dying 30-day post-discharge relative to dying in hospital increased in 2009 compared to 2000, especially for stroke (OR4.02;CI 3.51–4.61) and MI (OR2.25;CI1.89–2.68). Smallest OR was found for COPD (OR 1.68; CI 1.39–2.04). The risk of survival relative to dying in hospital increased in 2009 compared to 2000, which indicates a decreased risk of dying in hospital versus survival (stroke: OR2.94;CI2.76–3.13 and MI: OR 3.08; CI 2.81–3.38). Conclusion: This study shows an increased 30-day post-discharge mortality between 2000 and 2009, while in-hospital mortality declined. Therefore there is a need for interventions decreasing post-discharge mortality. P401 Do your patients know who you are?
M. Mozos Mutuam, Spain
F. Ehsanullah, R.L. Chu, J.T. Healy, D. Morganstein Chelsea and Westminster Hospital, London, United Kingdom
Introduction: The urgent medical attention to geriatric population in nursing homes has been historically delivered in the A&E unit of the Central Regional Hospital (CRH). Since May 2013, we have introduced a new system of advanced domiciliary care for nursing homes from 8am to 8pm, formed of a physician and a nurse. We analyse the impact of this service on the number of visits to the A&E unit. Methods: We analysed the data available from May 2012 to February 2013 and compared it to the data available from May 2013 to February 2014. We analysed the number of elderly people who attended A&E unit, the date and time of arrival, and discharge. The data was provided by the CRH. Results: In the period from May 2012 to February 2013, the number of residents visiting the A&E unit were 1450 (Monthly average: 145; SD: 9.18). Since the introduction of advanced domiciliary care, in May 2013, the number of residents attended was 1246 (monthly average: 124.6; SD: 11.1). The number of residents who visited A&E unit decreased by 16.10% (p < 0.001), a reduction of 203 visits, compared to the period from May 2012 to February 2013. Conclusions: Advanced domiciliary care decreases the number of patients visiting the A&E unit. Our results are preliminary, since the new system is in its initial phase. The effectiveness of the advanced domiciliary care should be reevaluated to confirm these promising results.
Introduction: The GMC’s Good Medical Practice states that doctors must ensure that all patients “understand [the doctor’s] role and responsibilities in the team, and who is responsible for each aspect of patient care”. We assessed what proportion of medical patients knew the name of their consultant, junior doctor and ward. Methods: All inpatients on general medical wards were surveyed over a week in a busy teaching hospital. Patients had undergone at least one consultant ward round. Exclusion criteria were: elective admissions, patients with an Abbreviated Mental Test Score below 7 and patients on the Acute Assessment Unit due to brevity of stay and transferring of care between doctors. Medical notes were reviewed to identify which doctors were caring for each patient. Results: Of a total of 88 inpatients identified, 46 met inclusion criteria. The mean age of patients surveyed was 74. 43% (n = 20) knew their consultant’s name, 15% (n = 7) knew the name of any of their junior doctors, and 41% (n = 19) knew their ward. Patients under 65 years were more likely to know their consultants name compared with those over 65 years (73% vs 34%, p = 0.037). Conclusions: Our study highlighted a striking lack of knowledge amongst patients regarding who their doctors were and their hospital location. Interestingly, older patients were less likely to know their consultant’s name which may contribute to disorientation when in hospital. We recommend that patients are given this information in a written form upon admission. This could improve accountability and also consolidate the doctor-patient relationship.
P400 Trends in in-hospital mortality and 30-day post-discharge mortality in acutely admitted older patients between 2000 and 2009 in the Netherlands M. van Rijn, B.M. Buurman, J.L. Macneil-Vroomen, E.P. Moll van Charante, S.E. de Rooij Academic Medical Center, Amsterdam, The Netherlands Introduction: Acutely hospitalized patients show high rates of inhospital mortality and 30-day post-discharge mortality. Over the past 10 years, in-hospital mortality has decreased for most diseases. However, it is unknown whether in-hospital mortality and 30day post-discharge mortality, in acutely hospitalized older patients decreased. Therefore, the aim of this study is to investigate trends in in-hospital mortality and 30-day post-discharge mortality for the six most prevalent acute diagnoses in patients 65 years and older. Methods: Retrospective data analyses were conducted for 263,746 patients aged 65 years and older who where acutely admitted for myocardial infarction (MI), heart failure (HF), stroke, chronic obstructive pulmonary disease (COPD), pneumonia and femur
P402 Readmissions after discharge from an acute geriatric unit; an analysis of probable causes A.H. Ranhoff, S. Alaburic, T. Engstad, L.K. Mensen, T. Svendsen Diakonhjemmet Hospital, Oslo, Norway Background: Readmissions after acute hospitalization in medical departments are frequent and often used as a quality indicator. Geriatric patients are at high risk for readmissions. The aim was to find characteristics of patients who had been readmitted after discharge from an acute geriatric ward. In 2012 the Coordination reform was implemented with intention to earlier discharge from hospital to primary care. Material and Methods: A retrospective observation study, using patient administrative data and medical record information from January-June in 2011 and 2013. Data about admissions and within30-days readmissions including primary diagnoses were obtained. Results: In January-June 2011, length of stay (LOS) was 8.2 days (mean), median 5.3, and 46 of 448 (10.2%) patients were readmitted.