Avoidable Hospital Admissions Research Articles

A case report of Steven Johnson’s Syndrome (SJS) /Toxic Epidermal Necrolysis(TEN) overlap caused by Nimesulide

Introduction: Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare, acute and life-threatening mucocutaneous diseases that are nearly always drug-related. Incidence of SJS and TEN is 0.05 to 2 persons per million populations per year. In India, Nimesulide is easily available as an over the counter drug (OTC), different cutaneous reactions associated with, Nimesulide including angioedema, maculo-papular rash, severe urticaria, pityriasis rosea and worsening of preexisting psoriasis. Patient concern (Case summary): A 17 years old female patient complained about fever and she was prescribed with Tab.Nimesulide twice daily by private practitioner. On the 3rd day of intake of oral Nimesulide, patient developed skin lesions over face, trunk, back and all four limbs. This reaction was diagnosed as Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) overlap by Nimesulide based on clinical picture and drug history. Interventions: Tab. Nimesulide was stopped and patient was admitted in dermatology ward. Patient was treated with Inj.Hydrocortisone sodium succinate 100mg iv twice daily, Inj.Cefotaxime 1gm iv thrice a daily, Inj. Metronidazole 500mg once a day and Liquid Cyclosporine 50mg twice a day for 10days. Other treatments included Inj. Albumin 100ml i.v slowly for 3 days given. Patient recovered and was discharged after 10 days. Conclusion: We are presenting a case of SJS-TEN overlap caused by Nimesulide, which is commonly used as an over the counter drug (OTC). Our aims to minimize this type of serious ADR by making alert to physicians and other healthcare professionals, we can avoid hospital admissions because of ADR, reduce economic burden of the patients and health related quality of life of the patient can be improved.

The feasibility, acceptability and appropriateness of screening for frailty in Australians aged 75 years and over attending Australian general practice

Background Globally, frailty is associated with a high prevalence of avoidable hospital admissions and emergency department visits, with substantial associated healthcare and personal costs. International guidelines recommend incorporation of frailty identification and care planning into routine primary care workflow to support patients who may be identified as pre-frail/frail. Our study aimed to: (1) determine the feasibility, acceptability, appropriateness and determinants of implementing a validated FRAIL Scale screening Tool into general practices in two disparate Australian regions (Sydney North and Brisbane South); and (2) map the resources and referral options required to support frailty management and potential reversal. Methods Using the FRAIL Scale Tool, practices screened eligible patients (aged ≥75 years) for risk of frailty and referred to associated management options. The percentage of patients identified as frail/pre-frail, and management options and referrals made by practice staff for those identified as frail/pre-frail were recorded. Semi-structured qualitative interviews were conducted with practice staff to understand the feasibility, acceptability, appropriateness and determinants of implementing the Tool. Results The Tool was implemented by 19 general practices in two Primary Health Networks and 1071 consenting patients were assessed. Overall, 80% of patients (n = 860) met the criterion for frailty: 33% of patients (n = 352) were frail, and 47% were pre-frail (n = 508). They were predominantly then referred for exercise prescription, medication reviews and geriatric assessment. The Tool was acceptable to staff and patients and compatible with practice workflows. Conclusions This study demonstrates that frailty is identified frequently in Australians aged ≥75 years who visit their general practice. It’s identification, linked with management support to reverse or reduce frailty risk, can be readily incorporated into the Medicare-funded annual 75+ Health Assessment.

Initial evaluation of a technologyenabled change in delivery of the dementia service during COVID-19 in North Warwickshire.

Remote monitoring technologies show potential to help health professionals deliver preventative interventions which can avoid hospital admissions and allow patients to remain in a home setting. To assess whether an Internet of Things (IoT) driven remote monitoring technology, used in the care pathway of community dementia patients in North Warwickshire improved access to care for patients and cost effectiveness. Patient level changes to anonymised retrospective healthcare utilisation data were analysed alongside costs. Urgent care decreased following use of an IoT driven remote monitoring technology; one preventative intervention avoided an average of three urgent interventions. A Chi-Square test showing this change as significant. Estimates show annualised service activity avoidance of £201,583 for the cohort; £8764 per patient. IoT driven remote monitoring had a positive impact on health utilisation and cost avoidance. Future expansion of the cohort will allow for validation of the results and consider the impact of the technology on patient health outcomes and staff workflows.

Risk factors for asthma-related hospital and intensive care admissions in children, adolescents and adults: a cohort study using primary and secondary care data

BackgroundAsthma remains a common cause of hospital admissions across the life course. We estimated the contribution of key risk factors to asthma-related hospital and intensive care unit (ICU) admissions in...

Enhancing discharge decision-making through continuous monitoring in an acute admission ward: a randomized controlled trial.

In Acute Admission Wards, vital signs are commonly measured only intermittently. This may result in failure to detect early signs of patient deterioration and impede timely identification of patient stability, ultimately leading to prolonged stays and avoidable hospital admissions. Therefore, continuous vital sign monitoring may improve hospital efficacy. The objective of this randomized controlled trial was to evaluate the effect of continuous monitoring on the proportion of patients safely discharged home directly from an Acute Admission Ward. Patients were randomized to either the control group, which received usual care, or the sensor group, which additionally received continuous monitoring using a wearable sensor. The continuous measurements could be considered in discharge decision-making by physicians during the daily bedside rounds. Safe discharge was defined as no unplanned readmissions, emergency department revisits or deaths, within 30 days after discharge. Additionally, length of stay, the number of Intensive Care Unit admissions and Rapid Response Team calls were assessed. In total, 400 patients were randomized, of which 394 completed follow-up, with 196 assigned to the sensor group and 198 to the control group. The proportion of patients safely discharged home was 33.2% in the sensor group and 30.8% in the control group (p = 0.62). No significant differences were observed in secondary outcomes. The trial was terminated prematurely due to futility. In conclusion, continuous monitoring did not have an effect on the proportion of patients safely discharged from an Acute Admission Ward. Implementation challenges of continuous monitoring may have contributed to the lack of effect observed. Trial registration: https://clinicaltrials.gov/ct2/show/NCT05181111 . Registered: January 6, 2022.

Virtual ward: The future in the management of neutropenic sepsis in the NHS

Virtual ward offers patients with neutropenic sepsis a unique opportunity to receive hospital level of care in the comfort of their home, especially for patients who would otherwise be admitted to hospital because of their acute treatment. On the virtual ward, patients can receive hospital level of care with a significant opportunity to mitigate any risk of hospital-acquired infection in this subset of patients who are already immunocompromised amongst other benefits. Additionally, hospital length of stay can be shortened leading to reduced admission pressure in hospitals, increasing hospital admission avoidance, and encouraging safe discharge from hospital while still providing the best care for the patients. We report a case of a 76-year-old cancer patient who presented with neutropenic sepsis and was successfully managed on the virtual ward in a district hospital. This case highlights the importance of virtual wards an evolving innovation that can define the future management of cancer patients in NHS. It is safe and reduces the cost of inpatient care in healthcare.

Health and economic burden avoided due to air pollution reduction during the COVID-19 Lockdown: Portugal case study

Since the onset of the COVID-19 pandemic, strict mobility measures and lockdown periods were implemented globally to curtail the spread of the virus. Thus, this study aimed to estimate the health and economic burden avoided due to the air pollution reduction during the COVID-19 lockdown in Portugal. PM10, NO2, and O3 hourly concentrations were obtained from Portugal's 68 air quality monitoring stations for the 2020 lockdown and historical (2015–2019) periods to estimate the avoided premature deaths, avoided asthma-related morbidity and avoided hospital admissions due to respiratory diseases, and related avoided costs. Overall, a higher number of avoided premature deaths was estimated, especially related to short-term NO2 exposure (less 30 %). Moreover, the highest avoided morbidity effects were estimated for the short-term NO2 exposure on hospital admissions due to respiratory diseases (57 % of avoided admissions). Economically, €48.3 million were avoided from the averted NO2-related premature deaths, and up to 0.1 % of the total health expenditure was saved due to the avoided new asthma cases in children aged 5–19 years old. In sum, the air pollution reduction during the 2020 lockdown relative to the historical period led to human health gains and related avoided economic costs.

Could Adequate and More Appropriate Housing for Aboriginal and Torres Strait Islander People in New South Wales, Australia, Reduce the Risk of Poorer Health Outcomes?

Objective: Indigenous Australians are estimated to be 3.7 times more likely to be living in overcrowded conditions and are more likely to have poorer health outcomes. To investigate correlations between housing, health and age of death, we used data from the Public Health Information Development Unit (PHIDU) on the 105 Indigenous Areas (IAREs) within New South Wales (NSW).
 
 Methods: Univariant and multivariant linear regression analysis of the Public Health Information Development Unit (PHIDU) database.
 
 Results: Our results indicate that for every 1% increase in crowded households in an IARE, avoidable hospital admissions increased by 130 cases per 100,000.
 
 Conclusion: We conclude that this finding is consistent with the view that decreased overcrowding could improve the health of Aboriginal people in NSW.
 
 Implications for public health: Increased housing availability could reduce the demand for health services, including public hospitals.

Long-term vitamin D insufficiency and associated risk factors for paediatric burns patients

The most recognised role of vitamin D in the body is for calcium absorption, and sufficiency is defined as a vitamin D blood serum level greater than 20 ng/mL (50 nmol/L). In growing children, hypovitaminosis D is associated with bone and muscle weakness, fractures, and osteoporosis. Burns patients are at a greater risk of low vitamin D levels due to lack of ultraviolet rays reaching the skin during prolonged hospital admission and sun avoidance post-burn injury. This study aimed to identify any individual, seasonal or burn injury characteristics in paediatric patients that were associated with low total vitamin D levels. Three different vitamin D metabolites were analysed to identify if, and where, in the synthesis pathway any insufficiencies may be occurring. Liquid Chromatography Mass Spectrometry (LCMS) was used to concurrently assess vitamin D3 (25OHD3 or Calcifediol), its epimer (3epi-25(OH)D3), and its precursor Pre Vitamin D3 (Cholecalciferol), in the plasma from 193 Australian paediatric burn patients, compared to 46 healthy controls. The results indicated that 61 % of healthy controls and up to 76 % of all burn patients had below normal clinical ranges of Total 25OHD3 (25(OH)D3 + 3epi-25(OH)D3). However, there were no significant differences between patient groups (control, acute, scarring, and reconstructive). The season of sample collection contributed significantly to total vitamin D levels but patients who were undergoing reconstructive surgery 1–17 years post-burn had consistently low vitamin D levels across all seasons. Routine screening, dietary monitoring, and potential supplementation of vitamin D in the burns population is recommended as it may impact recovery, growth and development of the child post-burn.

Prospective evaluation of single-dose aminoglycosides for treatment of complicated cystitis in the emergency department.

Antimicrobial resistance among Enterobacterales continues to be a growing problem, particularly in those with urinary infections. Previous studies have demonstrated safety and efficacy with the use of single-dose aminoglycosides in uncomplicated cystitis. However, data in complicated infections are limited. Single-dose aminoglycosides may provide a convenient alternative for those with or at risk for resistant pathogens causing complicated urinary infections, especially when oral options are unavailable due to resistance, allergy, intolerance, or interactions with other medications. This study evaluated the safety and effectiveness of single-dose aminoglycosides in treatment of complicated cystitis in the emergency department (ED). This was a multicenter, prospective study performed between July 2022 and March 2023 of patients who met criteria for complicated cystitis and were otherwise stable for discharge at an academic ED. Primary outcomes were clinical or microbiologic failure within 14 days of treatment. Safety was assessed by review of adverse events. Descriptive statistics were used. Thirteen patients were included. Complicating factors were male sex (n = 4), kidney stone (n = 2), urinary catheter (n = 6), recent urologic procedure (n = 1), urinary hardware (n = 1), antibiotic allergy precluding use of alternate oral options (n = 4), immunocompromised status (n = 2), and <1-year history of multidrug-resistant organisms on urine culture (n = 8). Eleven patients (85%) had positive urine cultures in the preceding 12 months with no oral antimicrobial option. Eight patients (62%) received amikacin (median dose 15 mg/kg), four patients (31%) received gentamicin (median dose 5 mg/kg), and one patient (8%) received tobramycin (5 mg/kg) for treatment. Ten patients (77%) reported resolved urinary symptoms after treatment and 11 patients (85%) reported no new urinary symptoms since discharge. No patient required hospital admission for treatment failure, and no adverse events were noted. Single-dose aminoglycosides appear to be a reasonably effective and safe treatment for complicated cystitis, which avoided hospital admission in this cohort.

Relationship between patient-perceived quality of primary care and self-reported hospital utilisation in China: A cross-sectional study

Background Reducing avoidable hospital admissions is a global healthcare priority, with optimal primary care recognised as pivotal for achieving this objective. However, in developing systems like China, where primary care is evolving without compulsory gatekeeping, the relationship between patient-perceived primary care quality and hospital utilisation remains underexplored. Objectives This study aimed to explore the association between patient-perceived primary care quality and self-reported hospital utilisation in China. Methods Data were collected from 16 primary care settings. Patient-perceived quality of primary care was measured using the Assessment Survey of Primary Care scale across six domains (first-contact care, continuity, comprehensiveness, accessibility, coordination, and patient-centredness). Hospital utilisation included patient self-reported outpatient visits, hospital admissions, and emergency department (ED) visits in the last six months. Logistic regression analyses were examined associations between self-reported hospital utilisation and perceived primary care quality adjusted for potential confounders. Results Of 1,185 patients recruited, 398 (33.6%) reported hospital utilisation. Logistic regression analyses showed that higher total scores for patient-perceived quality of primary care were associated with decreased odds of hospital utilisation (adjusted odds ratio(AOR): 0.417, 95% confidence interval (CI): 0.308–0.565), outpatient visits (AOR: 0.394, 95% CI: 0.275–0.566) and hospital admissions (AOR: 0.496, 95% CI: 0.276–0.891). However, continuity of care was positively associated with ED visits (AOR: 2.252, 95% CI: 1.051–4.825). Conclusion Enhanced patient-perceived quality of primary care in China is associated with a reduction in self-reported overall hospital utilisation, including outpatient visits and hospital admissions. However, better continuity of care may be associated with increased ED visits. Further research is warranted for precise insights and validation of these findings.

Investigating the relationship between FRailty And Quality of LIfe in patients with heart faiLure and CKD (FRAIL study).

Patients with chronic kidney disease (CKD) or heart failure (HF) are disproportionally affected by frailty, an independent predictor of morbidity. The prevalence of frailty and its impact on quality of life (QoL) in a unique population of patients with both CKD and HF (CKD-HF) is unclear. The aim of this study was to investigate the association between frailty and QoL in patients with CKD-HF. Patients were identified from a tertiary care cardiorenal clinic. Eligible patients had CKD-HF with a stable estimated glomerular filtration rate of <60mL/min/1.732 . Data were collected from each participant at one point in time using surveys delivered by study personnel between 14 July 2022 and 31 March 2023. Frailty was defined as Modified Frailty Phenotype (MFP) score ≥3. The Medical Outcomes Study 36-item Short Form Health Survey (SF-36) was used to assess QoL. Demographic data were retrospectively collected from electronic patient records. Demographics and QoL were compared between frail and non-frail cohorts using Pearson's R and Student's t-test (two-tailed, alpha-priori=0.05). One hundred five participants consented, and 103 completed the questionnaires in full. Amongst the 103 participants, 49.5% (n=51) were frail. Frailty was related to sex (P=0.021) and medication count (P=0.007), however not to other clinical measures, including estimated glomerular filtration rate (P=0.437) and ejection fraction (P=0.911). Frail patients reported poorer QoL across physical functioning (P<0.001), general health (P<0.001), bodily pain (P=0.004), social functioning (P<0.001), and energy levels (P<0.001), however not emotional wellbeing (P=0.058); 51.5% cited 'better quality of life' as their healthcare priority, over longer survival (23.3%) or avoiding hospital admissions (22.3%). This was consistent across frail and non-frail groups. A large proportion of CKD-HF patients are frail, regardless of disease severity, and more susceptible to significantly poorer QoL across physical and social domains. Improving QoL is the priority of patients across both frail and non-frail cohorts, further emphasizing the need for prompt recognition of frailty as well as possible intervention and prevention.

Variations in avoidable hospital admissions and emergency visits by primary care characteristics: an ecological study in Italy.

Primary healthcare plays a central role in providing preventive care, managing chronic conditions and reducing inappropriate emergency presentations. The study aimed at providing population-level evidence on the correlation between the characteristics of primary healthcare across Italian regions and health outcomes included in the National Programs Outcomes of the National Agency for Regional Healthcare Services. Ecological study. We analysed healthcare data from the National Agency for Regional Healthcare Services, the public lists of primary care doctors and the National Federation of Surgeons and Dentists and the National Institutes of Statistics referring to the 20 Italian regions. Pearson's correlation and Spearman's correlation were used to assess the relationships between primary healthcare characteristics and health outcomes. Overall, across all Italian regions each general practitioner had on average 1447 patients and was 57.5 years old. The study found positive correlations between the number of patients per general practitioner and non-urgent Emergency Department visits among adult patients (Pearson's r = 0.58, p = 0.008), the number of residents aged 65+ per general practitioner and the rate of chronic obstructive pulmonary disease admissions (Pearson's r = 0.49, p = 0.029), and the age of general practitioners and lower-extremity amputations in diabetes patients (Pearson's r = 0.56, p = 0.011). A negative correlation was observed between the age of general practitioners and urinary tract infection admissions (Pearson's r = -0.76; p < 0.001). A non-linear negative correlation was found between the age of general practitioners and chronic obstructive pulmonary disease admissions (Spearman's ρ = -0.46, p = 0.041). The findings emphasise the importance of guaranteeing sufficient numbers of primary healthcare physicians to meet patients' needs, and for limiting avoidable hospitalisations and emergency presentations. General practitioners' age might also influence the provision of care, but more research is needed on possible mechanisms.

Impact of Geriatric Consult Evaluations on Hospital Admission Rates for Older Adults.

We examined the impact of a geriatric consult program in the emergency department (ED) and an ED observation geriatric care unit (GCU) setting on hospital admission rates for older ED patients. We performed a retrospective case control study from June 1-August 31, 2019 (pre-program) to September 24, 2019-January 31, 2020 (post-program). Post-program geriatric consults were readily available in the ED and required in the GCU setting. Hospital admission rates (outcome) are reported for patients who received a geriatric consult evaluation (intervention). We analyzed probability of admission using a mixed-effects logistic regression model that included age, gender, recent ED visit, Charlson Comorbidity Index, referral to ED observation, and geriatric consult evaluation as predictor variables. A total of 9,663 geriatric ED encounters occurred, 4,042 pre-program and 5,621 post-program. Overall, ED admission rates for geriatric patients were similar pre- and post-program (44.8% vs 43.9%, P = 0.39). Of 243 geriatric consults, 149 (61.3%) occurred in the GCU. Overall admission rates post-program for patients receiving geriatric intervention were significantly lower compared to pre-program (23.4% vs 44.9%, P < 0.001). Post-program GCU hospital admission rates were significantly lower than pre-program ED observation unit admission rates (14/149, 9.4%, vs 111/477, 23.3%, P < 0.001). In the logistic regression model, admissions post-program were lower when a geriatric consult evaluation occurred (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.41-0.83). Hospital admissions for older ED observation patients were also significantly decreased when a geriatric consult was obtained (GCU vs pre-program ED observation unit; OR 0.27, 95% CI 0.14-0.50). Geriatric consult evaluations were associated with significantly lower rates of hospital admission and persisted when controlled for age, gender, comorbidities, and ED observation unit placement. This model may allow healthcare systems to decrease potentially avoidable hospital admission rates in older ED patients.

The rise of home death in the COVID-19 pandemic: a population-based study of death certificate data for adults from 32 countries, 2012–2021

During the coronavirus 2019 disease (COVID-19) pandemic, health systems had to respond to the needs of COVID-19 patients, while caring for patients with other life-threatening conditions. Pandemics, such as the COVID-19 pandemic, stir global health and mortality patterns. This is likely to include trends in dying places. In this paper, we examine trends in place of death for adults in 32 countries, comparing the initial COVID-19 pandemic years (2020-2021) with the eight years before the pandemic (2012-2019). Data on place of death for all adults (18 years and over) that died from 1 January 2012 to 31 December 2021 were requested (47 countries approached, 32 included). The classification of place of death varied widely between countries. "Home" was the most common category, the remaining category groups comprised "hospital or health institution", "other defined", and "ill-defined". We analysed place of death data in an aggregate form, by sex, age group, and selected underlying causes of death (cancer, dementia, and COVID-19). The study included 100.7 million people (51.5% male, 68.0% with ≥70 years), 20.4% died from cancer and 5.8% from dementia; 30.8% of deaths took place at home. The percentage of home deaths rose from 30.1% in 2012-2013 to 30.9% in 2018-2019 and further to 32.2% in the pandemic (2020-2021). Home deaths increased during the pandemic in 23 countries. In most countries the rise was greater in women and cancer; age differences were not consistent. Our study shows that there was a rise in home deaths during the pandemic, but with variability across countries, sex, age, and causes of death. The sex difference observed in most countries may have several explanations, including more engagement of women in discussions about end of life care planning and hospital admission avoidance. A higher rise of home deaths among people dying of cancer may be explained by the more predictable disease trajectory compared to non-malignant conditions, as well as earlier and better integrated palliative care. This work is part of the EOLinPLACE Project, which has received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement No 948609).

Trends in inequalities in avoidable hospitalisations across the COVID-19 pandemic: a cohort study of 23.5 million people in England

ObjectiveTo determine whether periods of disruption were associated with increased ‘avoidable’ hospital admissions and wider social inequalities in England.DesignObservational repeated cross-sectional study.SettingEngland (January 2019 to March 2022).ParticipantsWith the approval of...

Caredoc Community Intervention Teams - Multidisciplinary Approaches to Delivering Care in the Community

Introduction: Caredoc Community Intervention Team (CIT) has been operating for 10 years and during that time has expanded its service to cover 6 regions in the South East of Ireland. A central objective of the service is delivering holistic and integrated care in the community that meets the needs of patients and their families. In 2021 the service model was enhanced to include Occupational Therapy and Physiotherapy professionals to the team to work collaboratively with Nursing colleagues, thereby reducing multiple hospital appointments and supporting early discharge from acute hospitals and community rehabilitation, particularly for elderly and clinically vulnerable patients, by shifting delivery of multidisciplinary care to patient’s homes.&#x0D; Aims, Objectives, Theory Or Methods: The CIT service is deployed 7 days a week, 365 days a year and bridges the gap between acute care and the patients who require it by providing access to timely, flexible, ongoing and personalised treatment in clients’ own homes for the duration of their illness, thus avoiding hospital admissions and enabling early supported discharge. For patients and their families this offers enormous relief and support, particularly while living with the Covid-19 pandemic, as the service provides a wide range of home-based assistance, from medication management to advice around necessary equipment and changes to the home environment to improve rehabilitation.&#x0D; Highlights Or Results Or Key Findings: Strong linkages with hospital and other community-based teams have been formed to ensure continuity of care for patients and optimisation of key healthcare resources – joint home visits with other CIT professionals involved in individual patients’ care have been coordinated to streamline and improve access to appropriate care. These links have also allowed for the co-design of structured referral pathways from local hospital clinics to the service, enabling the CIT Team to offer care to patients requiring regular monitoring at home, thereby reducing unnecessary hospital visits and supporting earlier supported discharge from acute hospitals. The impact of this interdisciplinary, collaborative approach has been hugely positive on patients’ health and wellbeing along with the additional benefit of decreasing pressure on hospital-based services.&#x0D; Conclusions: The diversity of disciplines within the CIT service ensures that all aspects of a patient’s recovery is managed, and the team’s on-going and effective communication strives to optimise individual treatment plans to achieve stabilisations, ensure patient safety, avoid hospital admission and enable supported earlier discharge. The team also provides acute nursing services to patients discharged to residential care, with the overall effect of increasing capacity and bed availability in local hospitals.&#x0D; Implications For Applicability/Transferability, Sustainability And Limitations: In just under a year of service the multidisciplinary CIT team carried out almost 10,000 visits to patient homes – each client referred to the service has an average of 3 encounters with the team, ensuring that multi-faceted reablement is achieved for patients while remaining in their own homes.

Avoiding Hospital Admissions and Delayed Transfers of Care by&amp;nbsp;Improved Access to Intermediate Care: A Simulation Study

Objective: The current waiting times for intermediate care in the Netherlands prohibit timely access, leading to unwanted and costly hospital admissions. For the city of Amsterdam, we propose alternative policies for improvement of intermediate care and estimate the effects on the waiting times, hospitalization, and the number of patient replacements.&#x0D; Design: Discrete Event Simulation (DES) study.&#x0D; Participants: Data was used of older adults that received intermediate care in Amsterdam, The Netherlands, in 2019. For this target group, in- and outflows and patient characteristics of the intermediate care were identified.&#x0D; Methods: A process map of the main pathways into and out of the intermediate care was. Non-public microdata of Statistics Netherlands was used to quantify the process map, after which a DES was performed.&#x0D; Results: By means of a sensitivity analysis with the DES, we show that the waiting times are not a result of a lack in bed capacity, but are due to an inefficient triage and application process. Older adults have to wait a median of 1.8 days for admission, leading to hospitalization. If the application process becomes more efficient and evening and weekend admissions are allowed, we estimate that the number of unwanted hospital admissions can be reduced from ca. 51% to 3%.&#x0D; Conclusion: This study shows that the bottleneck in a care system is not always solved by increasing bed capacity. A data-driven approach is essential to identify problems’ true causes and appropriate solutions, which results in strongly increased cost-effectiveness and patient satisfaction.

Facilitating cooperation through promotion of good practices

Zorgnet-Icuro vzw is in Belgium the umbrella organisation of the Flemish general hospitals, initiatives in mental healthcare and social profit facilities in long-term care for older people. Our care facilities aim to offer high-quality, affordable and accessible care.&#x0D; Zorgnet-Icuro is the Flemish employers’ federation for healthcare, inclusing the care councils of the Flemish primary care zones and palliative care networks. Furthermore, Zorgnet-Icuro functions as a network playing an active role in exchanging knowledge, ideas and good practices in healthcare.&#x0D; Promoting, sensitising and facilitating concepts of integrated care is of one of our main objectives for the future.&#x0D; In the past we made several position papers and we have held stakeholdermeetings with our members about this subject.&#x0D; The next step in our plan was to collect good practices about collaboration between different actors involved in an integrated care program.&#x0D; We asked our members to give us the good practices based on the following criteria:&#x0D; -How do you assess the added value of the collaboration for the person with a care and/or support request and the quality of the care provided?&#x0D; -Collaboration between more than 2 different organisations or healthcareworkers&#x0D; -Preferably a combination of health and welfare&#x0D; -What is the aim of the collaboration?&#x0D; -In which way did it had impact on the way of working of the different partners but also on the needs of the people?&#x0D; -Reduce fragmentation in services delivery through well-coordinated care with focus on continuity of care.&#x0D; Based on this feedback, we want to give concrete input to the authorities for the organisation and financing of integrated care.&#x0D; In this workshop we first want to explain our vision and trajectory we have followed in the past years and give an overview of these good practices of collaborations. (15 minutes)&#x0D; Based on the criteria above we want to give the opportunity to 4 initiatives to show what they have done and go in interaction with an international public about the successfactors and the obstacles. For each presentation we provide a time slot of 10 -15 minutes, followed by discussion with the group in round tables.&#x0D; The 4 projects are:&#x0D; 1.Welgerust: integrated care for people with sleep disorders&#x0D; 2.Pathway ‘addiction to drugs and alcohol’ based on deployment of experience experts throughout the whole chain of care with collaboration of hospital, city, welfare organisations and primary care. &#x0D; 3.Verbindingscoach: a coach which helps the healthcare professionals and the people with healthcare problems related to social factors (e.g. poverty) to reach the right welfare actor or organisation.&#x0D; &#x0D; The bridge: In a exploratory short stay the health and well-being situation of the elderly person is observed and his social context is mapped out with all primary care and welfare actors involved, to search the best solution for this person and/or avoid hospital admission.&#x0D; &#x0D; The take home messages will be a summary of the points of attention, obstacles and recommendations from the healthcare and welfare providers from the field.&#x0D; &#x0D;

Community Intervention Team Management of Urology patients in the Community

Introduction: Urinary catheters are a necessary and frequent intervention in the acute clinical setting but can be successfully implemented in a patient’s home with the appropriate protocols. Caredoc Community Intervention Teams (CIT) work closely with local hospitals to establish structured, streamlined referral pathways for patients requiring catheterisation to be managed in the community, thus reducing hospital admissions and visits. Caredoc CIT nurses have been equipped with the requisite skills to successfully manage urology patients, many who are post-operative, outside of the hospital setting, ensuring that this cohort can be managed safely at home with the support of family and/or carers.&#x0D; Aims, Objectives, Theory Or Methods: The purpose of the CIT urology pathway is to provide rapid acute nursing care interventions to patients in their own homes. Patients are identified by urology consultants at local hospitals or by their GPs and referred to CIT for a period of continuous care, with home visits carried out by specialist nurses during a defined timeframe. This facilitates both early hospital discharge and admission avoidance as well as reducing waiting lists for outpatient ambulatory and scheduled care. This shared care initiative aims to transition vital urinary catheter care to the community resulting in a person-centred approach that keeps discharged patients comfortable and well in their own environment.&#x0D; Highlights Or Results Or Key Findings: Patients are managed safely in their own homes by the CIT Team for the duration of their ongoing treatment. By providing a spectrum of catheter care and education, such as teaching patients on the colour of their urinary output, how and when to empty their drainage bag and how to use a fluid balance sheet to record volume emptied, patients are given the knowledge to monitor their urinary output and are enabled to recognise potential red flags for infection and any catheter-related issues that may debilitate or affect their quality of life, with a particular emphasis on the prevention of sepsis in older patients. 24-hour catheter care support is offered by way of a telephone line for patients and their carers should they need advice - prior to the instantiation of the CIT service, patients with subrapubic catheters in residential care or who sought care in the out-of-hours were referred to emergency department via ambulance transfer, as the specialism required for management of these patients was not otherwise available.&#x0D; Conclusions: The CIT Team have successfully demonstrated integrated care pathways for managing patients requiring catheterisation in the community, leading to positive patient outcomes and experiences as well as having a significant impact on urology waiting lists and emergency department attendances. &#x0D; Implications For Applicability/Transferability, Sustainability And Limitations: Sustainability of this process is guided by an integrated, systematic approach to proactive care of people who require catheter care at home, with the aim to improve delivery methods, reduce the burden on acute hospitals and achieve better patient outcomes.