District General Hospital Research Articles

EP502 - Outcome of 5 years of endoscopic oesophageal stenting: a retrospective analysis

Abstract Background Oesophageal endoscopic stenting has a wide range of indications however dysphagia and use in cancer of the oesophagus is by far the most common, being the 14th most common cancer in the UK, despite advances in diagnosis and therapy with patients often presenting at advanced stages of the disease. Greater than 50% of presentations are at an advanced stage of disease where resection is often not possible and palliation is required. Palliation often is a potential combination of palliative chemotherapy, radiotherapy and endoscopic stenting to control the disease burden and improve symptoms. One of the most limiting palliative symptoms is dysphagia for which oesophageal stenting has become the standard of treatment showing immediate results. However, intra/post procedural complication rates can be high leading to: oesophageal perforation, mediastinitis, aspiration pneumonia, failed stent insertion or slippage. Method A retrospective analysis of 97 patients who underwent oesophageal stenting, in a 5 year time period between 2018-2023 in the Dumfries Royal Infirmary, a large district general hospital. Patients electronic notes were retrospectively analysed for patient characteristics, indication for stenting, early complications, successful hospital discharge and mortality. Conclusion The retrospective study demonstrated oesophageal stenting is a relatively safe procedure with a low mortality and the majority of patients being discharged from hospital. However, complications are not uncommon and patients should be properly counselled; on the risks, benefits and also food habits to prevent bolus.

EP503 - A retrospective assessment of quantitative futility in emergency laparotomy using pre-operative frailty as the predictor

Abstract Background Recent literature has proposed that emergency laparotomy in the frail population may be qualitatively futile leading to negative desired morbidity and missed opportunities for palliation. The aim of this study was to appraises the futility of emergency laparotomies within a 3 month period based on the predictor of pre-operative frailty with in a large district general hospital. Method Retrospective analysis of all patients undergoing emergency laparotomy in a 3 month time period in the Dumfries Royal Infirmary. Futility was defined as all-cause mortality within 3 days of emergency laparotomy and frailty based on the characteristics set out by the Rockwood frailty score. A assessment of surgical futility in emergency laparotomy was carried out based on the pre-operative frailty. Conclusions Increased frailty demonstrates an increase in futile emergency laparotomies. It is therefore recommended that a multidisciplinary team approach with careful assessment and consent should be made prior to any surgical intervention on this patient cohort.

WP6.16 - A comparison of post-rotation confidence levels over a year of surgical foundation year one doctors in a busy district general hospital

Abstract Aims Assess the confidence levels of foundation year one (FY1) doctors in managing surgical patients post-rotation. Identify areas where further support could be given to improve confidence levels. Methods August 2022, December 2022 and April 2023 cohorts were surveyed following the end of their four-month rotation. Ten questions used Likert scales (1 to 5: not at all confident to very confident) to assess general surgical patient management. One question focused on education methods and one was an open question. Data was initially inputted using Google Docs and analysed in Microsoft Excel. Results 100% (10/10) August 2022 cohort, 38% (3/8) December 2022 and 80% (8/10) April 2023 cohort completed the survey. Modal post-rotation confidence levels were mostly four and five across all cohorts. August 2022 and December 2022 cohorts had a modal value of three for confidence in speaking with a patient’s family when a patient was dying. August 2022 cohort had a modal value of three for confidence in speaking to a patient when their condition was unknown. Common concerns of FY1 doctors were managing a deteriorating patient and being unable to contact a senior. Most FY1 doctors felt that case-based discussion would be the preferred method to increase understanding of general surgery. Conclusions Confidence levels were high post-rotation and increased throughout the year. This could suggest that FY1 doctors are receiving a good understanding of general surgery by the end of their rotation. Further work needs to be done to target improvement in areas of lower confidence.

WP1.18 - A Surgical Post-Take Ward Round Checklist Proforma: A Prompt for Improved Documentation

Abstract Aims Surgical ward rounds are often swift, therefore documentation of diagnostic and management decisions is frequently incomplete. The Royal College of Surgeons of Edinburgh (RCSEd) devised a ward round checklist toolkit to improve documentation of surgical post-take ward rounds. Methods We conducted a baseline audit of our district general hospital general surgery post-take ward round documentation, based on the RCSEd checklist. Documentation in each domain was recorded for each ward round entry for both pre and post intervention groups. Control patients were identified from the surgical take list across 7 different days in a month. The checklist toolkit was then adapted into a proforma for our institution and used on post-take ward rounds for a trial period of 7 days. Results 40 patients were included in the pre-intervention group, 17 in the post intervention group. Following the introduction of the post take ward round proforma, documentation of most recent observations improved from 40% to 82%, admission blood results from 27.5% to 94%, and imaging results from 42% to 90%. Areas of existing good practice improved; history and examination findings were documented in 100% of patients, an improvement from 80% pre-intervention. Nil by mouth status was documented in 80% of cases, up from 50%, and IV fluid requirement in 58%, up from 10%. Conclusions A proforma for post take ward rounds improved documentation of key diagnostic and management information. As a result, we recommend a standardised approach to documentation to encourage consistency of recording key information in the patient record.

ThP7.18 - Post-operative management and outcomes in emergency laparotomy - an audit of the updated 2023 NELA Standards in a busy district general hospital

Abstract Background The updated NELA Standards, encourage pre-operative decision-making, were published and utilised from April 2023. Our busy district general hospital has not been audited against these updated standards. Methods Single-centre, retrospective audit of emergency laparotomies between April 2023 and December 2023. Patients were included if the NELA risk score was ≥5% (‘high-risk’) or if they were deemed ‘high-risk’ based on clinical judgement. Demographic, management, and outcome data were collected from the local NELA database and EPR. The primary outcome was the proportion of ‘high-risk’ patients directly admitted to critical care. The secondary outcome was to investigate differences between high-risk patients admitted to critical care and those admitted to ward care using length of stay (LOS) and 30-day observed/expected (O/E) mortality ratio. Results 112 laparotomies were performed and 43 (38%) were deemed ‘high-risk’. Of ‘high-risk’ patients, the median age was 73 (44 - 95), 56% were male, and the median mortality risk was 10.5% (3.1% – 62.7%). 38 ‘high-risk’ patients were directly admitted to critical care. They had a median LOS of 14 days (3 – 72) and 7 died within 30 days with an O/E mortality ratio of 1.12. None of the 5 patients admitted directly to the ward died and they had a median LOS of 8 days (3 – 39). Conclusion The mortality risk score is a tool for post-operative management in emergency laparotomy but appropriate clinical judgement can prevent excessive care and preserve critical care beds.

FP5.12 - Write what you know: A retrospective documentation audit

Abstract Aims The Royal College of Physicians (RCP) stipulates that every patient entry in the notes should be; dated, timed and signed by the author (name and designation included). Additionally, the content should have a standardised structure and layout with a chronological order to reflect a continuum of patient care. This audit aimed to assess the percentage of patient documentations that were compliant with these standards. Methods We retrospectively evaluated inpatient documentations for general, colorectal and vascular surgery for one week within a district general hospital setting. The data was obtained from electronic documentations. We assessed inpatient documentation for all relevant criteria as per RCP guidelines. Inpatient documentation included; the admission notes, post take ward round, daily ward rounds and inter-speciality discussions. Results A total of 88 patient related entries were reviewed. Of these 89.8% were dated. 42.0% of the entries were timed, with inter-specialty discussion having the highest percentage of recorded times. 93.2% had a standardised structure. The structure of admission entries was the most consistent with standards. 6.8% and 3.4% had the authors designation and signature respectively. Conclusion Clear informative documentation is pivotal for safe and effective patient care. Failure of patient documentation to meet the stipulated standards was established in this audit. Factors including inadequate junior doctor training, pace of ward rounds and reliance on electronic noting systems are potential reasons for poor compliance. Capitalising on opportunities to educate junior doctors is paramount in improving patient care.

Improving the Accuracy of the Gynaecology Handover Process: An Effective Quality Improvement Project at a University Hospital in the United Kingdom.

Objectives The objective of this study was to introduce a new system of handover in the gynaecology department and ensure its effectiveness with dynamic improvement measures. This was launched as a quality improvement project in a district general hospital in the United Kingdom. The primary aim was to start and consolidate a new system of a separate gynaecology handover in the presence of consultants, registrars (incoming and outgoing), senior house officers (incoming and outgoing) and gynaecology nurses. Design The strategy for consolidation included a daily quality review on the basis of a fixed proforma, identifying the obstacles faced, and improvising dynamic solutions. A new quality check proforma was introduced which took into account: (i) Presence of team members, (ii) Following of proper SBAR (Situation, Background, Assessment, Recommendation) format in the handover, (iii) Updating of patients awaiting surgeries with every detail on the list, (iv) Proper handing over of pending referrals, (v) Mention of sick patients with proper importance, and (vi) Proper handing over of new admissions. A pilot study was done to evaluate the baseline performance of the unit regarding the gynaecology team handover on the basis of the same proforma. The result of the baseline study was noted as the reference. Each day the team receiving the handover was interviewed for the next five months about the quality of each of the parameters on the predesigned proforma and the responses were noted. The answers were designed in binary form (Yes/No). These results were compiled at the end of each month. The result from each individual month was reviewed and the problems were identified and practical solutions were applied. These changes were noted and plotted graphically as a bar diagram. The monthly audit results were tabulated in an Excel sheet (Microsoft Corporation, Redmond, Washington, United States). Results Pilot study results and final month results were compared with the help of the Mcnemar test and statistically significant improvement was noticed in seven out of eleven parameters. There was a steady and gradual improvement in the responses. The possible limitations of the study were also noted at the same time. Conclusion The quality improvement project was highly effective in improving the quality of handover and increased patient safety to a large extent.

Experiences and outcomes in shoulder replacements in a district general hospital over 19 years.

This study aimed to evaluate the changing experiences of shoulder surgeons working in a district general hospital. A consecutive series of 395 shoulders (225 male, 170 female) over a 19-year period (2000-2019) with a minimum follow-up of 2 years were analyzed. Outcome measures were length of stay, operating time, satisfaction visual analog score (VAS), pain VAS, Oxford Shoulder Score (OSS), Constant-Murley score, range of movement, complications, and implant survival. The incidence of a diagnosis of osteoarthritis as the surgical indication increased over time. The number of cases by surgeon per year increased from three cases in 2,000 to a peak of 33 in 2011. Up to seven implant manufacturers were used. The incidence of hemiarthroplasties decreased, and more numerous reverse polarity and anatomic arthroplasties were performed (P<0.001). More glenoid and humeral components were cemented and more short-stem implants were used in later years (P<0.001). Length of stay was a median of 1 day with a trend towards daytime surgery in recent years. Patients were satisfied (VAS 8/10) and OSS improved by 8 points on average throughout the observation period. Despite frequent introductions of new implants, patient outcome, satisfaction, and complication rates remained good. There appears to be a need for large-scale, generalizable studies to understand why technological advancements leading to changes in implants do not influence clinical outcomes. Level of evidence: III.

Understanding progression in multiple sclerosis: analysis of an in-patient admissions audit

Analysis of in-patient data is valuable to reduce avoidable admissions, which are disruptive to patients and costly to the NHS. The audit aimed to identify causes of in-patient admissions of people with multiple sclerosis at a district general hospital. The audit comprised a retrospective evaluation of secondary in-patient admissions data. Primary causes of admissions included chest infections, falls and urinary tract infections. Secondary progressive multiple sclerosis accounted for the largest number of admissions by multiple sclerosis sub-type, disproportionate to representation on the multiple sclerosis nurse caseload. In contrast, primary progressive multiple sclerosis was represented proportionally. Given the crossover between the two sub-types, this paper explores potential reasons for disproportionate representation by sub-type. Several factors may contribute to the admissions data by sub-type, including patient understandings of progression and information provided by clinicians. These findings have implications for the information and support provided by multiple sclerosis services.

External Fixators as a Tool for Damage Control Orthopedics in Severely Injured or Polytrauma Patients.

The purpose of this study is to explore the use of damage control techniques in the emergency surgical management of polytrauma patients - those with traumatic injuries affecting at least two anatomical regions - at a District General Hospital in Greece. We conducted a retrospective review of medical records from patients who visited the orthopedic emergency department between 2021 and 2024. From approximately 10,000 injured patients treated annually in our emergency department, we selected a sample of 29 polytrauma patients who required surgical intervention. We utilized the Injury Severity Score (ISS) to evaluate these patients. For 16 patients, the initial surgical intervention was also the definitive treatment, utilizing intramedullary nailing or internal osteosynthesis techniques. In the remaining 13 patients, damage control techniques, including external osteosynthesis (ExFix), were employed. The ISS was the primary criterion for deciding between definitive management and damage control procedures. Data on the 13 patients managed with damage control techniques were further analyzed and are presented in this study. External osteosynthesis was used to stabilize fractures and control bleeding, particularly in patients with multiple orthopedic injuries such as femoral or diaphyseal tibial fractures. This approach facilitated resuscitation and recovery. Our findings suggest that stabilizing long bone fractures with external fixation in patients with an ISS greater than 9 is both safe and likely contributes to overall recovery. This study demonstrates that a damage control approach for polytrauma patients with significant orthopedic trauma is effective for fracture stabilization and bleeding control. Additionally, in three cases, this approach also served as the definitive treatment.

The role of day-case thoracoscopy at a district general hospital: A real world observational study

ObjectiveTo assess the feasibility and safety of talc pleurodesis performed as part of day-case medical thoracoscopy. MethodsA Richard Wolf® 5 mm mini thoracoscope through a 5.5 mm port was used with eligible cases having talc poudrage followed by insertion of indwelling pleural catheter (IPC). District nurses drain the IPC daily for the first 5 days. Once the drain output is <150 mL, the frequency is progressively reduced to once weekly. The drain is removed after two consecutive dry taps 1 week apart. ResultsOverall, 51 patients underwent day-case thoracoscopy. Median time to removal of IPC for our day-case protocol was 14 days. There were seven deaths within 70 days among 41 patients with malignant pleural effusion in the day-case cohort, compared to eight deaths in the 33 conventional thoracoscopy controls. Overall, the day-case cohort observed a statistically significant reduction in all-cause mortality at 180 days compared to the conventional cohort (log rank p = 0.024). The average cost per patient of the day-case and inpatient cohort was £1,328.0 ± 106.0 and £1,835.0 ± 295.0 (p = 0.961). ConclusionThis study suggests that thoracoscopy and talc poudrage can be performed safely as a day-case procedure. Further data are needed to ascertain long-term outcomes.

An audit on the management of hypophosphataemia on the wards in a district general hospital in the UK

Hypophosphataemia or low serum phosphate, if severe can be life-threatening. However, mild hypophosphataemia is quite common and usually asymptomatic. Symptomatic hypophosphataemia (normal: 0.8-1.5 mmol/L) is usually observed when serum phosphate falls below 0.3 mmol/L. Complications may include myopathy, rhabdomyolysis, respiratory failure. cardiac arrhythmias, cardiomyopathy, acute heart failure. delirium, seizures, metabolic encephalopathy and coma. Severe hypophosphataemia can also be related to anaemia, infection, osteomalacia, insulin resistance, ileus and renal tubular failure. Therefore, an audit was carried out for 1 month at the beginning of 2024 to find out whether hypophosphataemia was properly managed on the wards in accordance with the prevailing Guidelines. The findings suggested that although blood tests for Parathyroid hormone (PTH), Cortisol and 24 hours urinary phosphate were done in a small number of patients, in most cases, the management of hypophosphataemia was adequate.

PENGARUH PENERAPAN STANDAR AKUNTANSI PEMERINTAH, SISTEM AKUNTANSI KEUANGAN DAERAH DAN KOMPETENSI SUMBER DAYA MANUSIA TERHADAP KUALITAS LAPORAN KEUANGAN PADA RUMAH SAKIT UMUM DAERAH KABUPATEN BANGLI

This study aims to examine the influence of the implementation of government accounting standards, regional financial accounting systems, and human resource competencies on the quality of financial reports at the Bangli District General Hospital. The study population consists of 181 employees from various departments, with a sample size of 45 people selected using Slovin's formula at a 25% margin of error. The research method used is quantitative, with primary data as the data source. Data analysis employs multiple linear regression analysis using SPSS. The results of this study provide empirical evidence that, partially, the variables of the implementation of government accounting standards, regional financial accounting systems, and human resource competencies have a positive effect on the quality of financial reports at the Bangli District General Hospital. Simultaneously, these variables significantly influence the quality of financial reports at the Bangli District General Hospital

Thrombolysis with tenecteplase in acute ischaemic stroke in a tertiary care setting in Sri Lanka: A retrospective study

Introduction: Alteplase (ALT) is the standard thrombolytic treatment in acute ischaemic stroke (AIS). Tenecteplase (TNK) is proven to be effective in acute coronary syndrome, is relatively cheap, widely available and can easily be given as a single intravenous (IV) bolus. Despite evidence for its use, there is equivocal guidance for the use of TNK in AIS. On the background of a global reduction in stroke admissions, treatment interventions and prolonged treatment time metrics due to the COVID-19 pandemic, this study highlights the experience with TNK in a tertiary care setting in Sri Lanka, during the pandemic.Objectives: To describe the outcomes at 48 hours among stroke patients who underwent thrombolysis with TNK at District General Hospital Hambantota, Sri Lanka over a period of one year.Methods: We retrospectively reviewed records of adults with AIS thrombolysed with 0.25 mg/kg TNK. The National Institutes of Health Stroke Scale (NIHSS) was assessed on admission and at 24-hours following treatment. Patients were observed for 48-hours for potential adverse events.Results: We thrombolysed 20 consecutive patients over one-year. The baseline mean NIHSS was 9.7 (standard deviation (SD)=4.4; range 4-22), and the 24h-post thrombolysis mean NIHSS was 6.0 (SD=7.3; range 0-28). Seventy percent (n=14) showed an improved NIHSS of at least 1-point after thrombolysis (mean difference=3.7; SD=6.46), and 55%(n=11) displayed a major clinical improvement (change in NIHSS ≥ 4). Ten percent (n=2) developed major adverse effects (one intra-cranial haemorrhage; one haemorrhagic transformation). There were no deaths.Conclusions: TNK 0.25mg/kg for the treatment of AIS appeared efficacious and safe in our case series. The limitation in this study was the low number of patients who underwent thrombolysis during the study period, as a probable effect of the COVID-19 pandemic. Thrombolysis with TNK could be a cost-effective alternative to alteplase in resource-limited South Asian settings.

The management of acute complete ruptures of the ulnar collateral ligament of the thumb.

Complete ruptures of the ulnar collateral ligament (UCL) of the thumb are a common injury, yet little is known about their current management in the UK. The objective of this study was to assess the way complete UCL ruptures are managed in the UK. We carried out a multicentre, survey-based cross-sectional study in 37 UK centres over a 16-month period from June 2022 to September 2023. The survey results were analyzed descriptively. A total of 37 centres participated, of which nine were tertiary referral hand centres and 28 were district general hospitals. There was a total of 112 respondents (69 surgeons and 43 hand therapists). The strongest influence on the decision to offer surgery was the lack of a firm 'endpoint' to stressing the metacarpophalangeal joint (MCPJ) in either full extension or with the MCPJ in 30° of flexion. There was variability in whether additional imaging was used in managing acute UCL injuries, with 46% routinely using additional imaging while 54% did not. The use of a bone anchor was by far the most common surgical option for reconstructing an acute ligament avulsion (97%, n = 67) with a transosseous suture used by 3% (n = 2). The most common duration of immobilization for those managed conservatively was six weeks (58%, n = 65) and four weeks (30%, n = 34). Most surgeons (87%, n = 60) and hand therapists (95%, n = 41) would consider randomizing patients with complete UCL ruptures in a future clinical trial. The management of complete UCL ruptures in the UK is highly variable in certain areas, and there is a willingness for clinical trials on this subject.

Provision of oral medicine in Scottish oral and maxillofacial surgery units: where are we and where are we going?

Introduction Oral medicine (OM) care occupies a significant quantity of oral and maxillofacial surgery (OMFS) outpatient clinical time. This survey aims to examine the current provision of OM care in OMFS units and explore opinions on how to improve the delivery of OM services across Scotland.Method An anonymous online questionnaire was distributed to all (33) OMFS consultants in Scotland. A range of questions were asked, covering place of work, formal OM training, proportion of time spent delivering OM clinical care, referral practices and support for a managed clinical network (MCN) in Scotland.Results A total of 18 (55%) OMFS consultants completed the survey. The majority of respondents (72%) worked in a university teaching hospital (UTH) setting. While none of the respondents were on the OM specialist register, most (72%) had received formal training in OM during their OMFS specialty training. Time dedicated to OM in outpatient clinics varied between less than 20% and 20-40% of clinical time. The majority of respondents (50%) referred 1-2 patients per month to OM. Most OMFS consultants (72%) felt that local OM services should be expanded and 78% would support the inclusion of OM specialists as part of the OMFS outpatient clinic team.Conclusion This study highlights the significant contribution to OM care within OMFS units in Scotland and emphasises the need for close collaboration between specialties. There is support for OM specialists to form part of the OMFS clinical team in UTHs or district general hospitals. Additionally, there is widespread support for the development of a MCN model of OM care in Scotland.

Patient reported outcome measures at a large district general hospital post-mastectomy and implant based reconstruction.

11 Background: Breast reconstruction surgery for cancer can be a debilitating and life changing experience for patients, with complex affects on physical and mental health throughout the rehabilitation journey. We conduct a study on a cohort of patients undergoing this procedure, with focus on patient reported outcome measures. Methods: We reviewed all patients who underwent breast reconstruction surgery at our hospital from 2017 to 20223. Demographic, diagnosis, pre- and post-operative adjuvant treatment, and implant characteristics were collected. Psychosocial well being, physical wellbeing, satisfaction with breasts scales of the BREAST-Q were used. Independent t-test was conducted to find differences between PROMs for each group, and linear regression of age and implant size on each score. Results: 69 patients were contacted and 39 PROMS collected. The average age of patients was 57.6 years old. 40% were previous or current smokers and 40.8% had BMI&gt;30. 29 had pre-pectoral placement and 40 sub-pectoral. 17 had smooth implants and 52 textured. The average size of implant was 330mm. Immediate reconstruction was associated with a lower psychosocial score (66.0vs86.9, p=0.02) compared to multi-stage implants. Sub pectoral placement was associated with a higher (75.7vs61.9 p=0.046) psychosocial score than pre pectoral placement. Textured surface was associated with lower physical score than smooth surface (34.7vs50.2 P=0.046). On linear regression, age was positively associated (p=0.007) with psychosocial score. Conclusions: These findings underscore the importance of personalized approaches in surgery, considering implant type, placement technique, and patient age. Surgeons should prioritize patient preferences and needs to optimize post-surgical satisfaction and well-being.

2317 Geriatrician-led perioperative services: an example of value-based care

Abstract Background Perioperative services must adapt to the needs of an increasingly older surgical population. Perioperative medicine for Older People undergoing Surgery (POPS) services integrate geriatric medicine teams into surgical pathways to provide quality and cost-effective medical care. This project aims to examine value-based outcomes (clinical and financial impact) of embedding a POPS service at a district general hospital. Methods Following a period of implementation on an acute Trauma and Orthopaedic (T&amp;O) ward, a two-week pilot was undertaken. All emergency fragility fracture admissions aged over 65 years with Clinical Frailty Scores (CFS) of ≥5 were included. Patients with hip fractures were excluded. The POPS service provided medical consultation, medicine rationalisation, proactive treatment escalation planning and shared decision making, as well as leading multidisciplinary team meetings. Outcome metrics: geriatric medicine consults, medical emergency team (MET)/cardiac arrest calls, staff/patient satisfaction and clinical coding. The REDUCE trial cost calculator was used to estimate savings. Results 35 patients were included, mean age 84 years, mean CFS score 7. Ward MET calls and cardiac arrest calls were reduced from a weekly average of 2.5 to 0, and weekly referrals to geriatric medicine reduced from 3 to 0. Experience-based design surveys identified thematic improvements relating to leadership, communication, dignity and respect. Improved quality of documentation resulted in the comorbidity score tariff increasing from £3325 to £6096 per patient. For services introduced by POPS including Comprehensive Geriatric Assessment and delirium assessments, the REDUCE trial cost calculator estimated an additional saving of £2926 per patient totalling hospital savings of £2 million per year (for an estimated 700 patients per year). Conclusion Implementation of a POPS service at a district general hospital can lead to cost savings, improved patient and staff experience, and improved clinical outcomes within a sustainable workforce model.

2336 Prevalence of anticholinergic burden across a cohort of frail older adults in a district general Hospital in South West Wales

Abstract Background and Objectives Polypharmacy is common in frail older adults who often live with multiple co-morbidities. This polypharmacy can carry a significant anticholinergic burden. Frail older adults are particularly sensitive to the anticholinergic side effects of medications which can include constipation, urinary retention and dry mouth. Medications with a high anticholinergic burden scores have also been evidenced to contribute to an increased frequency of falls, cognitive decline and increased mortality. For frail older adults, a medication review, considering anticholinergic burden, is therefore an essential part of Comprehensive Geriatric Assessment. A local frailty census was completed for all medical inpatients over the age of 65 years old and as part of this anticholinergic burden scores were collated. Materials and Methods As part of this whole hospital frailty census, an anticholinergic burden score (ACB) was calculated for 77 inpatients. This was calculated using the Anticholinergic Cognitive Burden Scales and Anticholinergic Burden scores. Results The average age of the patients was 80.19 (± 9.35). 80.01% of patients were taking one or more medications with an anticholinergic burden. Of those, 40.25% had a significant ACB score of 3 or more (3–8). The patients with the highest ACB scores were those with multi-morbidity, an already established diagnosis of dementia and patients with recurrent falls. Conclusions The ACB score for patients included within this frailty census appeared to correlate with certain co-morbidities as would be expected from the known complications associated with these medications in frail older adults. The proportion of our inpatients with a significant ACB score informs us that we need to develop a more robust approach to delivering polypharmacy reviews as part of Comprehensive Geriatric Assessment within our hospital and will help us to inform future service planning and delivery.

2222 Individual telephone calls to frail older adults improve outpatient clinic attendance rates

Abstract Introduction The multidisciplinary assessment clinic (MDAC) is an outpatient service for older people at a district general hospital. Patients are triaged to the MDAC clinic if they have geriatric syndrome (for example falls) plus comorbidity and/or mobility, social or cognitive concerns. The service had a high ‘did not attend’ (DNA) rate compared with other geriatric outpatient clinics. This project aimed to reduce MDAC DNA rates and improve cost effectiveness through implementation of a new pre-appointment telephone service. Method We analysed six months of attendance data prior to establishing the pre-appointment telephone service. The existing system consisted of a standardised trust appointment letter and a text message reminder. For the new system a healthcare assistant (HCA) telephoned patients the day before their appointment to confirm attendance and discuss any concerns. We analysed six months of attendance data following the implementation of the new system and compared DNA rates. Results Prior to implementation of the new pre-appointment telephone service, 29 of 268 patients DNA (11%). From the second data set, following implementation of the new telephone system, 11 of 253 patients DNA (4%). Successful contact was made with 72% of those phoned, allowing confirmation or cancelled appointments to be rebooked. Chi square analysis found a significant difference between the two systems, with a p value of &amp;lt;0.01 indicating an improvement in attendance rates with the new system. Conclusion Telephoning frail older patients prior to an outpatient clinic appointment significantly reduces DNA rates—a similar system could be implemented in other geriatric medicine outpatient settings.