Medical Unit Research Articles

Kaizen-led utilization improvement at medical oncology daycare unit.

293 Background: Optimizing utilization of oncology day care units is key in throughput, patient experience and minimizing errors. At our oncology center, the medical oncology day care (MODC) unit was at a infusion chair/bed utilization rate of 92% with a turnaround time for multiagent or long-infusion chemotherapeutic regimens of 275 minutes. This resulted in prolonged wait times for patients and delayed treatment initiations appointments. Therefore, we set out to improve the utilization of the treatment chairs and chemotherapy turnaround time at the MODC. Methods: The goal of this project was to increase MODC chair/bed utilization up to 150% and decrease chemotherapy infusion time by 30% by the end of 4/2024. The interventions integrated Agile Project Methodology to ensure adaptability and responsiveness, with DMAIC (Define, Measure, Analyze, Improve, Control) serving as the guiding quality improvement tool for the improvement plan. Interventions began with project charter approval involving stakeholders from all relevant departments, followed by a comprehensive assessment and gap analysis using DMAIC to identify and address wasted steps in the process. This involved process mapping to streamline operations and eliminate unnecessary tasks. Key interventions included pre-chemotherapy blood work 48 hour prior to treatment, patient segmentation based on treatment session-length, proactive communication with patients regarding treatment session times, and coordination with the chemotherapy pharmacy for medication readiness. Furthermore, strict adherence to defined timelines for patient assessment and chemotherapy order placement was enforced. A sensitive Key Performance Indicator (KPI) structure was developed to measure the outcomes of the interventions, aligning with Agile principles for continuous improvement. Sustainability was ensured through the creation of a sustainability plan aligned with a dashboard to maintain success thresholds. Results: The results demonstrated significant improvements; MODC median bed utilization increasing to 168%, single-agent infusion turnaround time reduced to 150 minutes (33% decrease), and long-agent infusion turnaround time decreased to 210 minutes (30% decrease). Sustainability studies are now underway. Conclusions: These findings underscore the effectiveness of interventions in not only increasing chemotherapy infusion center capacity but also decreasing chemotherapy turnaround time utilizing a Kaizen-led approach.Results of these interventions are expected to enhance efficiency and improve patient care within the MODC unit.

The Clinical Utility of a Hand-Held Piezoelectric Scanner in the Detection of Early Tumor and Changes in Breast Texture.

Background Breast cancer (BC) is one of the leading causes of cancer death in females worldwide. Screening with mammography (MMG) is limited in low- and middle-income countries (LMICs). The implementation of an affordable and effective screening method is crucial. The intelligent breast examination (iBE) has emerged as a portable device with a glove shape using piezoelectricity.This experimental study evaluates the effectiveness of the device by comparing it with mammography (MMG), breast magnetic resonance imaging (MRI), and clinical breast examination (CBE). Methods This study included patients admitted to the senology unit who were under surveillance in a medical oncology unit. iBE was performed after each CBE and compared with Breast Image Reporting and Data System (BI-RADS) classifications. MMG/MRI was classified as negative (BI-RADS ≤2) or positive (BI-RADS ≥3). Measures of accuracy and agreement between tests were calculated. Results A total of 103 females were included between September 2022 and September 2023, who underwent iBE, CBE, and MMG/MRI. CBE and MMG showed moderate agreement in categorization (ρ=0.99). With a specificity for predicting a negative MMG of 90.8% and a negative predictive value of 79.7%. Benign findings, cysts, fibroadenoma, and benign microcalcifications were presented in 80 patients (seromas and non-suspicious hypoechogenic images). The performance of iBE was evaluated by comparing the breast with alterations to the control breast within each BI-RADS categorization. Conclusion As of now, iBE does not identify breast changes. The improvement proposals emphasized the incorporation of accelerometer sensors, signal conditioning to allow for the collection of compression and decompression data from the sensors, and consideration of pressure stress. These improvements are crucial to optimize the iBE's ability to detect changes in breast texture, enhancing the iBE's effectiveness in the early detection of BC.

Early taxane exposure and neurotoxicity in breast cancer patients

IntroductionBreast cancer is the most diagnosed tumor and a leading cause of cancer death in women worldwide. Taxanes are the most used chemotherapeutic agents and are strictly connected to neurotoxicity. Taxane-induced neuropathy (TIN) significantly impacts patients’ quality of life (QOL). Early identification and management of TIN could improve preventive strategies to preserve patients’ QOL during and after breast cancer treatment.ObjectiveThis prospective, observational study aimed to evaluate the taxane-induced neuropathy (TIN) in early breast cancer patients treated with weekly paclitaxel at an earlier stage and identify any correlation between TIN and QOL.MethodsData from stage I-III breast cancer patients treated with taxane-based therapy between 2018 and 2022 were collected at the Medical Oncology Unit of the University Hospital of Cagliari. Peripheral neuropathy was evaluated using the NCI-CTCAE scale (National Cancer Institute, Common Terminology Criteria for Adverse Events) at every drug administration. In contrast, QOL was assessed using EORTC QLC-CIPN20 and FACT-Taxane questionnaire at baseline (T0), after 4 weeks (T1) and 12 (T2) weeks of treatment. Statistical analysis was performed to evaluate the correlation between neurotoxicity and QOL.ResultsNeurotoxicity incidence peaked at the third, fourth, and sixth week of treatment, with patients reporting grade 1 and 2 neurotoxicity. Simultaneously with increasing doses of paclitaxel, significant differences in QOL were observed in early treatment cycles relating to TIN presentation. Patients with higher neurotoxicity grades reported lower QOL scores.ConclusionsDespite the absence of effective treatments to prevent paclitaxel-induced neurotoxicity, symptoms are managed through dosage reduction, delay, or treatment interruption. Future research should focus on identifying neuroprotective measures to avoid an irreversible decline in the quality of life for breast cancer survivors.

Использование беспилотных летательных аппаратов в интересах военной медицины: современное состояние и перспективы

Summary. The of the study is to analyze existing experience and determine the prospects for using unmanned aerial vehicles (UAVs) in the interests of military medicine based on published data. Materials and research methods. The research materials were scientific articles, conference materials and other internet resources. Research methods: analytical, logical, descriptive-comparative, analogies. The results of the study and their analysis. As a result of the analysis, it was confirmed that the potential of these UAVs to provide medical care in dangerous and remote areas is huge, but the implementation of such a system is far from unambiguous due to unresolved problematic issues such as ensuring security, increasing survivability, and compliance with safety requirements when using UAVs. In addition, the legal regulation of ethical issues of drone use cannot be ignored. And the most important thing is the economic justification, that is the matching of the costs of developing the necessary products to the increase in efficiency during their use.

The repeatability of stride time variability, regularity, and long-range correlations

BackgroundDetrended fluctuation analysis (DFA) and sample entropy (SE) measure the long-term correlations and regularity of gait patterns, respectively, having previously been used to identify participants at risk of falling, previous history of injury, or patients with motor diseases. Since these measures are more sensitive to gait impairment than linear measures (e.g., the standard deviation [SD] of stride time), they can be potentially used in military medicine to identify soldiers at risk of injury. However, clinometric properties are yet to be established. Research QuestionWhat is the repeatability of DFA, SE, and traditional linear measures of stride time variability (SD and coefficient of variation [CV]) under various load and speed constraints? MethodsFourteen Australian Army trainee soldiers (age: 25.6 ± 5.9 y, height: 1.74 ± 0.08 m, body mass: 77.2 ± 15.1 kg, service: 1.5 ± 1.8 y) attended three sessions over two weeks, completing four 12-minute walking trials on an instrumented treadmill in each session. Participants walked with a combination of 0 kg or 23 kg loads at a self-selected or 5.5 km/h speed. Heel contacts from the right foot were identified using treadmill-embedded force plates. From 512 stride time intervals, linear (SD and CV), and non-linear (DFA and SE) measures were obtained. To assess the between-session repeatability, intraclass correlations (ICC 2,1) were employed. Results and SignificanceThere was poor-to-moderate repeatability for the SD (ICC: 0.357–0.545) and CV (ICC: 0.371–0.529). DFA showed poor-to-moderate repeatability (ICC: 0.013–0.504), while SE had poor repeatability (ICC: 0.133–0.226). Previous studies have shown that differences of > 0.19 in DFA and > 0.66 in SE can differentiate between healthy and pathological gait. These values are greater than this study's reported standard error of measurement, indicating that clinically meaningful changes may still be detectable despite low repeatability.

Outpatient Rehabilitation Utilization After Major Limb Loss in Adults Receiving Care in the Military Health System From 2001 to 2017

ObjectiveTo investigate exposures associated with outpatient rehabilitation encounters among Military Health System (MHS) beneficiaries with major limb loss. DesignRetrospective, cohort study. SettingAmerican military treatment facilities and civilian health care facilities that accept TRICARE benefits. ParticipantsAdult MHS beneficiaries with major limb amputation(s) acquired between January 2001 and September 2017 (N=5161). InterventionsNot applicable. Main Outcome MeasuresThis exploratory analysis investigated associations between outpatient rehabilitation care and demographic and amputation characteristics in MHS beneficiaries with major limb loss. ResultsMost beneficiaries were aged 55-64 (36%), male (73%) and retirees/dependents (60%) with enlisted sponsor rank (88%) and single limb loss (89%). The active/reserve beneficiaries were younger, majority male, and more likely to be diagnosed with incident behavioral health conditions. Unadjusted negative binomial regression models revealed increased rates of outpatient rehabilitation encounters in active-duty service members (ADSMs) than in retirees/dependents (rate ratio, 10.02; 95% confidence interval, 9.30-10.80). The rate ratios for sex, sponsor rank, limb(s) lost, incident behavioral health condition, incident traumatic brain injury, incident posttraumatic stress disorder, and outpatient care setting were attenuated after stratification by beneficiary category. Enlisted ADSMs had increased rates of outpatient rehabilitation encounter days compared with officers, whereas retirees/dependents with enlisted sponsors had decreased than those with officer sponsors. ADSMs who accessed outpatient care in direct and private care settings demonstrated high rates of outpatient rehabilitation encounters compared with those who only sought care from private care settings (rate ratio, 4.60; 95% confidence interval, 2.95-6.81). ConclusionsThis study suggests that MHS beneficiaries with major limb loss use outpatient rehabilitation services differently, based on active/reserve duty or retiree/dependent status. This study is the first of its kind to quantify outpatient rehabilitation utilization for military beneficiaries with all-cause major limb loss and may inform MHS policymakers on the rehabilitation needs for combat- and noncombat-related amputee populations.

Racial Disparities in SGLT2 Inhibitor (SGLT2i) and Glucagon-Like Peptide 1 Receptor Agonist (GLP-1 RA) Use in the US Military Health System (MHS)

Racial Disparities in SGLT2 Inhibitor (SGLT2i) and Glucagon-Like Peptide 1 Receptor Agonist (GLP-1 RA) Use in the US Military Health System (MHS)

Using a Military-Civilian Partnership to Enhance Clinical Readiness and Sustainment for Air Force Critical Care Nurses.

Decreases in size, capability, clinical volumes, case mixes, and complex care opportunities in military treatment facilities contribute to the atrophy of clinical skills among medical professionals in these facilities. The COVID-19 pandemic resulted in a 39% decline in admissions to a military critical care unit. The decrease in patient census contributed to skill sustainment challenges. To identify methods to combat skill atrophy, the CINAHL and PubMed databases were searched using the terms peacetime effect, military-civilian partnership, and skill sustainment. Active-duty critical care nurses stationed at a military treatment facility implemented a military-civilian partnership with a civilian medical facility for clinical skill sustainment. One year after implementation, 39 critical care nurses had completed 511 shifts, gaining clinical experiences seldom achieved at the military facility. A survey of these nurses demonstrated that 8 of 17 (47%) gained experience treating patients requiring intra-aortic balloon pumps or continuous renal replacement therapy, 6 of 17 (36%) gained experience with patients requiring a ventricular assist device, 12 of 17 (71%) acquired hands-on experience with intracranial pressure monitoring, and 14 of 17 (82%) reported vasoactive intravenous infusion manipulation. This article highlights the importance of evaluating clinical practice within the military health system, developing military-civilian partnerships, and removing military-civilian partnership barriers for nurses and other health care professionals. Failure to implement military-civilian partnerships may adversely affect the clinical competency of the military nurse force.

CKD Testing among Patients with Diabetes in the US Military Health System

CKD Testing among Patients with Diabetes in the US Military Health System

Factors associated with mental healthcare utilization among United States military personnel with posttraumatic stress disorder or depression symptoms

Introduction: Although posttraumatic stress disorder (PTSD) and depression are prominent mental health conditions affecting United States service members, only a subset of individuals with these conditions utilize mental healthcare services. Identifying factors associated with mental healthcare utilization may elucidate military subgroups with unmet mental healthcare needs. Methods: Cross-sectional survey data from the 2019–2021 Millennium Cohort Study assessment were used to examine correlates of unmet mental healthcare needs among military personnel who screened positive for PTSD or depression symptoms (n=18,420) using modified Poisson regression models. Data analyses for this study were conducted between 2023 and 2024. Results: Approximately 32–43% of service members reported receiving any mental healthcare in the past 12 months. Hispanic and Asian or Pacific Islander personnel, and those with certain service characteristics (higher pay grade, recent deployment, experienced discrimination) had a lower likelihood of mental healthcare utilization. Female sex, greater symptom severity, experiencing bullying, and other psychosocial factors were associated with greater likelihood of mental healthcare utilization. Conclusions: One-third of service members with PTSD or depression symptoms reported any mental healthcare use, highlighting the need to identify factors that may impede or delay treatment. Racial and ethnic disparities in treatment utilization persist as do differences in utilization by military characteristics. Further research and initiatives are necessary to identify potential service-specific or cultural barriers and provide equitable quality and access to needed mental health services within the Military Health System.

Nutritional screening on hospital admission and one-year clinical outcomes in a prospective cohort of older patients

Background & AimsMalnutrition negatively affects the prognosis and quality of life of hospitalized patients. However, there are several gaps between evidence-based knowledge and current clinical practice. Our primary aim was to describe the prevalence of malnutrition risk in a cohort of in a cohort of older inpatients; secondly, we explored its predictors and its independent impact on 12-month survival. MethodsProspective study focused on patients aged 65 years and older consecutively admitted for any reason to the acute geriatric and general medical units of an Italian university hospital. Comprehensive geriatric assessment data, including the short form of the Mini Nutritional Assessment (MNA-SF), were collected within 48 hours of admission. The prevalence of malnutrition and risk of malnutrition according to the MNA-SF represented the main outcome. Correlations among clinical variables, nutritional status, and one-year survival were analyzed using multivariable and Cox models. ResultsAmong 594 patients (median age: 84 years, 49.5% female), mostly living at home with moderate functional autonomy, 82.3% were identified as probably malnourished or at risk of malnutrition according to MNA-SF (39.9% and 42.4%, respectively). Malnutrition and the risk of malnutrition were positively associated with living alone at home (OR 2.803, 95%CI 1.567-5.177, p<0.001), and negatively associated with autonomy in IADL (OR 0.765, 95%CI 0.688-0.846, p<0.001) and the best performance at HST (OR 0.901, 95%CI 0.865-0.936; p<0.001). After 12 months, 31.8% of patients was dead and mortality was positively correlated with malnutrition according to MNA-SF (OR 2.493, 95%CI 1.345-4.751, p=0.004), institutionalization (OR 2.815, 95%CI 1.423-5.693, p=0.003) and severe cognitive impairment (OR 1.701, 95%CI 1.031-2.803, p=0.036). ConclusionMalnutrition is common among older inpatients upon admission, primarily influenced by their functional and cognitive status, and it is linked to a worse prognosis. Early incorporation of thorough nutritional and functional assessments into clinical practice is crucial to improve prognosis prediction and enable timely, focused interventions targeting modifiable causal factors in a patient-centered approach.

EVALUATING THE IRON DEFICIENCY ANEMIA IN TYPE-II DIABETIC PATIENTS TAKING METFORMIN AND ITS ASSOCIATION WITH OXIDATIVE STRESS

Iron deficiency anemia (IDA) is one of the most common nutritional disorders worldwide, affecting individuals across various demographic groups. Objective: The main objective of the study is to find iron deficiency anemia in type-II diabetic patients taking metformin and its association with oxidative stress. Methods: This cross-sectional observational study was conducted at the outpatient department (OPD) of the Medical Unit at Khawaja Muhammad Safdar Medical College, Sialkot, during the study period from 1st January 2024 to 31st June 2024. Data were collected from 285 patients diagnosed with type 2 diabetes mellitus (T2DM) who were receiving metformin therapy. Patients were divided into two groups—Group A (patients with IDA) and Group B (patients without IDA)—and the oxidative stress markers were compared between these two groups. Results: Data were collected from 285 patients with 92 in Group A (IDA) and 193 in Group B (Non-IDA). The mean age of participants was 57.6 ± 9.4 years, with no significant difference between Group A (58.2 ± 9.1) and Group B (57.3 ± 9.6) (p = 0.422). Gender distribution was similar between groups (p = 0.601). The mean duration of diabetes was also comparable between the groups (8.3 ± 3.4 years in Group A and 8.0 ± 3.1 years in Group B, p = 0.572). However, HbA1c levels were significantly higher in Group A (8.3 ± 1.6%) compared to Group B (7.5 ± 1.3%) (p = 0.012), indicating poorer glycemic control in the IDA group. Conclusion: This study concludes that iron deficiency anemia (IDA) is prevalent among type 2 diabetic patients on metformin therapy, affecting approximately one-third of the study population. Additionally, there is a significant association between IDA and increased oxidative stress, as evidenced by elevated levels of malondialdehyde (MDA) and reduced antioxidant enzymes (SOD and GPx) in patients with anemia.

ENHANCING SOLDIER RESILIENCE: ACUPUNCTURE TECHNIQUES FOR PAIN AND STRESS MANAGEMENT ON THE FRONTLINES

This article examines the growing interest in acupuncture as a potential treatment on the battlefield, particularly for pain relief and aiding the recovery of soldiers. This trend is part of a broader movement toward the integration of complementary and alternative medicine (CAM) into military healthcare systems. The article highlights how acupuncture’s holistic approach, which differs significantly from traditional Western medicine, makes it particularly effective in managing pain by considering the physical, psychological, and other patient characteristics that contribute to imbalances. Modern research and evidence further support the integration of acupuncture into pain management strategies, especially in military contexts. The article also explores the development and application of Battlefield Acupuncture, a protocol designed for rapid pain relief in combat settings. Additionally, the introduction of innovative approaches, such as finger acupuncture for self-help on the battlefield, offers a practical and low-risk alternative for soldiers in field conditions where access to comprehensive medical care may be limited. The effectiveness, simplicity, and potential for self-treatment make acupuncture a valuable tool in military medicine, particularly in resourceconstrained environments.

NURSING KNOWLEDGE AND PRACTICE REGARDING THE PREVENTION OF PRESSURE ULCER

Pressure ulcers are a significant concern in healthcare settings, particularly patients with limited mobility. Nurses play a critical role in preventing pressure ulcers through early identification and intervention. However, the effectiveness of preventive measures largely depends on nurses' knowledge and practices regarding pressure ulcer prevention. Objective: This study aimed to assess the knowledge and practices of nurses working in tertiary care hospitals in Pakistan regarding the prevention of pressure ulcers. Methods: A descriptive cross-sectional study was conducted among 129 nurses at Jinnah Hospital, Lahore. Data were collected using a structured questionnaire that included demographic variables, knowledge, and practice sections related to pressure ulcer prevention. Descriptive statistics were used to summarise the data, and inferential statistics were applied to analyse the associations between knowledge, practices, and demographic variables. Results: Most participants were female (86.8%) and between the ages of 26 and 30 (55.0%). Most nurses had 1-3 years of experience (79.8%), and 38% held a Bachelor of Science in Nursing. While 62.8% of the nurses correctly identified that pressure ulcers result from unrelieved pressure for more than three hours, only 42.6% consistently used a risk assessment scale for pressure ulcer prevention. Significant gaps in knowledge and practice were observed, particularly regarding implementing prevention strategies. Conclusion: The findings indicate that while nurses in tertiary care hospitals in Pakistan have a basic understanding of pressure ulcer prevention, there is a need for continuous education and training programs to improve their practical application of preventive measures. Targeted interventions, particularly in high-risk departments such as medical and ICU units, could significantly reduce the incidence of pressure ulcers in hospitalised patients.

Results From A Snapshot Survey Of Delirium Prevalence, Detection And Care In Hospitals In Ireland On World Delirium Awareness Day

Abstract Background Delirium, an acute encephalopathy characterized by acute onset, fluctuation, and attention deficits, is associated with increased mortality and morbidity, and with precipitation or worsening of dementia. Thus, delirium prevention, timely detection, and appropriate management are crucial. Methods On World Delirium Awareness Day (15th March 2023), a global survey was assessed delirium prevalence and care. A senior clinical staff member on each participating ward reported on delirium prevalence at 8AM and 8PM, and on usual ward practice; data was entered into an online survey by a data collector (typically an on-site clinician, visiting several wards to record data). This study reports data from Irish hospitals. Results In total, 132 wards from 15 hospitals across Ireland participated. Delirium prevalence, using a formal assessment tool, was 15.9% across all wards, highest in geriatric wards (20.5%). However, on wards where 'personal judgment' to detect delirium was utilized, the prevalence rate was 11.5%, implying that delirium may be missed on these wards. Intensive care units (76.2%), geriatric wards (70%), and Emergency Departments/Acute Medical Units (ED/AMUA; 66.7%) had the highest rate of written delirium protocols. Similarly, staff training (51.5% overall), was highest in ED/AMAU (88.9%), followed by general surgical (66.7%), and geriatrics wards (60%). In contrast, only 30.8% (4/13) of non-acute wards had provided staff with delirium training in the preceding year. Having at least one training session in the preceding year was associated with higher use of formal delirium tools (18.8% versus 60.3%). Wards reported staff training/educating as the main care improvement priority; 72.7% of wards identified lack of time to train staff as a key barrier. Conclusion Delirium is prevalent in Irish hospitals and appears under-detected without formal screening. Training staff in delirium-related skills, including the use of simple screening tools for delirium detection and causation, could be paramount to improving patient outcomes.

An Audit of Time to Inpatient Bed In Patients With A Suspected Delirium

Abstract Background Our local Dementia/Delirium Combined Pathway and Care Bundle for Emergency Department (ED) and Acute Medical Assessment Unit sets a target door to ward admission in patients aged over 65 years with a suspected delirium at less than 6 hours. This audit assessed if this target is being met in patients with a suspected delirium. Methods Retrospective point prevalence audit of 240 randomly selected patients who were assessed by the Frailty Intervention Team (FIT) in the Mater Misericordiae University Hospital ED in 2022, aged ≥ 65 years with a suspected delirium (4AT ≥4) and no delirium (4AT=0). Time of presentation to ED, time of admission to ward bed, ward name and length of hospital stay were recorded. Results The median age in patient's with a 4AT ≥4 was 86 years (range 65-99). There was an equal spread across gender groups in patient's with a 4AT ≥4; 55.3% (n=52) females and 44.7% (n=42) male. The median wait time in ED for patients with a 4AT ≥4 was 25.26 hours (range 6.75-83.73) vs 21.65 hours (range 5.98-50.53) in patients with a 4AT=0. Only 19% (n=18) of patients with a 4AT ≥4 were admitted to a Specialist Geriatric Ward. The mean length of stay in patients with a 4AT ≥4 was 28.457 days vs 14.132 days in those with a 4AT=0 (p value=0.002, Mann-Whitney U test). Conclusion Older adults with a delirium spend prolonged periods of time in the ED. We are not meeting our local target of 6 hours from ED presentation to ward bed. Length of hospital stay is prolonged in patients with delirium. Our aim is to create a dedicated delirium bed on our Geriatric Specialty Ward so that we can provide delirium specific care and reduce overall length of hospital stay.

Community Flexible Endoscopic Evaluation Of Swallowing (FEES): A Prospective Cohort Study Of Clinical, Process And Patient-Reported Outcomes

Abstract Background Dysphagia prevalence increases with age, impacts on quality of life and increases healthcare utilisation and cost (Atrill 2018). Instrumental swallowing assessment is essential for accurate diagnosis and treatment of dysphagia but can be difficult to access in the community. FEES is a gold-standard instrumental assessment delivered by speech and language therapists (SLTs). The aim of this abstract is to report clinical, process and patient-reported outcomes of participants who had a community FEES over a 6-month period. Methods A prospective cohort study recruiting adults who accessed community FEES in Ireland's Mid-West. Baseline assessment data (demographics, a range of validated tools and process data) were recorded at index visit. A structured phone interview was completed at six months. The primary outcome was the rate of medical complications potentially caused by dysphagia at follow-up. Secondary outcomes included healthcare utilisation, dysphagia severity, functional status and quality of life. Results 62 participants were recruited: mean age: 70.98 (SD=15.01), 55.4% were female. At follow-up, 27.42% reported medical complications potentially attributable to dysphagia, 27.4% had attended general practice, 3.23% attended medical assessment units, 6.45% attended emergency departments. 82.26% were diagnosed with dysphagia or modified independence: Dysphagia Outcome Severity Scale (DOSS) ≤6, (M=5.2, SD=1.53). Changes to dysphagia care plans were recommended in 60.94% of cases. There was significant difference in Functional Oral Index Scale (FOIS) scores across time, F (1.75, 106.78) = 5.38, p = 0.008. FOIS scores at 6 months (M=5.92, SD=1.50) were significantly higher than pre-FEES (M=6.42, SD=1.37). Significant differences in quality of life (EQ5D5L-VAS) scores p&amp;lt;0.001 were detected: higher scores at 6-months (M=69.35; SD=20.42) compared to index visit (M=64.52; SD=19.44). Conclusion Access to community FEES for older persons may improve outcomes by reducing the frequency of dysphagia-related complications and healthcare utilisation, improving functional swallowing status, enhancing quality of life and contribute to evidence-based dysphagia diagnosis and care planning.

Development of a Hospital Wide Inpatient Frailty Screening Pathway in a Model-2 Hospital

Abstract Background Our model-2 hospital is experiencing a higher proportion of frail older adults presenting to our medical assessment unit (MAU) and via direct ward admissions. Frailty increases the risk of co-morbidity, falls and mortality during hospital admission. Screening for frailty a point of admission allows early identification of these patients who are at higher risk of adverse outcomes. Early frailty screening also assists healthcare professionals with multidisciplinary team (MDT) management and treatment plans. Our hospital frailty committee established a frailty screening pathway for all inpatients aged 75 years and older to screen for frailty and minimise the risk of adverse outcomes secondary to frailty. Methods A hospital wide consultant chaired frailty committee was established with stakeholders from the MDT. Two separate screening pathways were developed, one for MAU admissions and one for direct ward admissions. A standardised frailty policy and standardised operating procedure (SOP) with algorithm illustration were compiled. Hospital wide education emphasised the development of a bespoke Clinical Frailty Score (CFS) sticker in conjunction with referral pathways to the newly established Clinical Nurse Specialist (CNS) For The Older Adult. In each pathway CFS-screening is completed for adults ≥75years at first-point of contact using the CFS, a score ≥6 triggers onward referral, CNS for inpatient and public health nurse for MAU discharged patients. Results Both pathways are established and used effectively and routinely on a daily basis. Associated educational sessions have emphasised the importance of frailty in our inpatient cohort. Conclusion The developed algorithms have been useful for identifying frailty and improving patient care with onward CNS referral. Future audits will assess effectiveness of screening and support advancement of frailty committee objectives via supporting business cases for resourcing.

An Exploration Of Delirium Awareness Amongst Clinical Staff Working On The Acute Floor Of A Level Three Hospital

Abstract Background Delirium is an acute change in cognitive function that has an organic cause and is likely to be reversible or preventable (HSE Delirium Algorithm, 2021). The Frailty Intervention Team (FIT) based in the Emergency Department (ED) &amp; Acute Medical Assessment Unit (AMAU) comprises of Physiotherapy, Occupational Therapy and Dietetics and is supported by an Older Persons Advanced Nurse Practitioner. The 4AT delirium screen is routinely completed by FIT as part of Comprehensive Geriatric Assessment. FIT observed limited use of delirium screening in ED/AMAU therefore we proposed to explore delirium awareness amongst all clinical staff on the acute floor. Methods All clinical staff in ED/AMAU were invited to complete an anonymised paper questionnaire to explore their awareness of delirium. Basic statistical analysis of data was completed using Excel. Results Over one week twenty-four questionnaires were completed by medical, nursing, allied health and health care assistants. Six questions explored delirium awareness and a seventh question explored the willingness to engage in delirium information sessions if made available to staff locally. On assessment of delirium awareness an average score of 79.3% (range 16.7%-100%) was achieved. Participants scored strongly on potential causes of and screening for delirium. Questions relating to delirium symptoms and potential outcomes of unrecognised delirium had the least correct response rates. 100% of respondents expressed interest in attending delirium information sessions if made accessible to them within ED/AMAU. Conclusion This study identified overall satisfactory delirium awareness amongst clinical staff on the acute floor and all participants expressed interest in expanding their knowledge in this area. Compliance with use of delirium screening tools in clinical practice was not assessed and we also acknowledge the limited number of participants. Future plans include audit of the use of delirium screening tools, delivery of delirium information sessions and provision of accessible delirium resources in ED/AMAU.

Optimising Care For Nursing Home Residents: Exploring The Potential Of An Emergency Department Avoidance Pathway

Abstract Background Nursing home residents (NHRs) often face hospital admissions through the emergency department (ED), leading to complications such as delirium, pressure ulcers, and functional decline. To mitigate these risks, ED avoidance models of care are becoming increasingly popular within healthcare systems. These models advocate for ambulatory pathways that provide access to multidisciplinary teams capable of delivering timely care for patients who do not require hospital admission. Methods A retrospective review of clinical data spanning 14 months (February 2023 to April 2024) was conducted, focusing on NHRs admitted to hospital for less than three days. Data were collected from electronic patient records, including age, sex, reason for admission, National Early Warning Score (NEWS), Manchester Triage (MT) score at admission, and length of stay in the ED. Results 325 NHRs were admitted medically during the study period. 18.7% (n=61) had inpatient stays of less than 36 hours. The most common reasons for ED presentation were lower respiratory tract infections, seizures, collapse or falls, and delirium. Of these patients, 51%(n=32) had a NEWS of ≤2, indicating low acuity, while 38% had an MT score of ≤3, suggesting lower urgency. The average patient experience time in the ED was 15.88 hours. Conclusion Approximately half of all short stay NHR admissions exhibited low acuity NEWS scores at the time of presentation, indicating the potential for an ambulatory care pathway for over 10% of all our NHR admissions. Implementing an ED avoidance pathway through our Acute Medical Unit could allow many of these patients to receive appropriate care without long periods in the ED, thereby reducing potential complications. These findings highlight opportunities to streamline care pathways and reduce unnecessary hospitalisations for NHRs. Implementing an ED avoidance service tailored to the specific needs of these patients could enhance care efficiency and improve patient outcomes.