Terms Of Planning Research Articles

Patients’ views and behaviours in relation to asthma inhalers use and their impact on environmental sustainability: a cross-sectional survey study

Abstract Introduction Approximately 60 million inhalers are used annually in England, contributing 3% to the National Health Service (NHS) carbon footprint. Of these, 2 out of 3 are metered-dose inhalers (MDIs) containing greenhouse gas propellants.[1] The carbon footprint of an MDI device is around 500g CO2 equivalent, in contrast with the 20g CO2 equivalent of a dry powder inhaler (DPI).[2] The NHS Long Term Plan introduced measures on environmental sustainability, leading to the National Institute of Health Care and Excellence (NICE) launching a ‘shared decision aid’ to promote the discussion of options for inhaler devices. This landmark policy step could be more effective if received with patient support and informed behaviours of patients with regard to inhalers. Research is therefore needed to identify patients’ views and behaviours on this matter. Aim To identify patients’ views and behaviours related to environmental sustainability aspects of their use of inhalers for the management of asthma. Methods An anonymous self-completion paper-based questionnaire was administered to patients with a clinical diagnosis of asthma. These were recruited opportunistically via 10 community pharmacies in the South of England during the month of February 2020. They were provided information about the study and invited to participate by pharmacy staff when collecting prescriptions. Participants had to be prescribed at least one MDI inhaler and not to be using a DPI, and report on the use, disposal and views regarding their environmental impact. Responses to the questionnaire were coded and analysed using descriptive statistics. Results A total of 149 surveys were completed by patients, of which 47% (n=70) were male and 53% (n=79) were female. The age range of respondents varied with the majority 45.6% being 18-29 years old, followed by 21.5% in the 60-69 years category. Of these, 30.2% (n=48) were aware of MDI inhalers having an impact on carbon footprint, and 53% (n=79) on plastic pollution. A majority (81%) of patients stated that they were involved or partially involved in their inhaler choice. Only 62% (n=92) said they would be willing to switch their MDI to a more environmentally friendly inhaler with equal effectiveness, 15.4% (n=23) reported they would not be willing to do so and 22.1% (n=33) were not sure. Unwanted inhalers were returned by 43% (n=64) of participants for appropriate disposal, with 55% (n=82) of respondents being unaware of this option. A majority (91%, n=136) of participants said they would like further information about their inhalers and their impact on the environment. Conclusion There is scope for a more environmentally friendly management of asthma and the use of inhalers. Healthcare professionals are involving patients in decision making when prescribing, and pharmacists could contribute to this when dispensing. Patients would welcome information on the impact of inhalers on the environment and further research could identify more precisely on what aspects, alongside barriers preventing a switch to more environmentally friendly options. A small sample size and geographical area were limitations of this study, which could be overcome by further researching issues identified in this survey.

Customer Demand Forecast Using Time Series Approach

Nowadays we are living in an uncertain time (pandemics, wars, inflation, shortages) and for companies, predicting the future of the business becomes more and more difficult. From this point of view, we can resort to statistical forecasting methods that, based on on past data and current external trends, can predict figures for the short and long term planning. The motive, the scope, behind this study is to develop a forecasting model using time series that can help the organisations and the managers in taking better decisions, on time, for the future of the company. The data that were used for this paper are focusing on forecasting the demands for the sales budgets only, starting with the historical data from a company in the glass mould manufacturing area. If we examine the current literature, we can find that there a few studies, with real business data regarding budgeting, therefore this study is relevant and important for the researchers and practitioners. This paper aims to illustrate how we can use the time series statistical method and the linear equation regression that can help the organisations to forecast and plan the business. The main findings after developing the model are that it allows smoothing the fluctuations of the series over time (especially if we find outliers) and eliminating the influence of seasonality, in order to obain in the end a good accuracy of the predictions. In order to measure the quality of the forecasting we can use many indicators, such as Mean Absolute Percentage Error.

Place-leadership and power in the futures domain: the case of Euskadi 2040

ABSTRACT In an era when uncertainty and complexity are more tangible than ever, decision-makers are under pressure to turn from short-term politics and departmentalization to safeguard not only current wellbeing but also the wellbeing of future generations via longer term planning and visioning. In regions, as multilevel governance systems, no actor has the power to determine the decisions of others. Place leadership demands the mobilization of different actors to define an effective strategy for future development, by combining institutional, interpretive and network power in a dynamic manner. This paper reflects on how leadership and power shape shared vision in regional foresight processes, and the role of academic knowledge. We conduct an in-depth single case study analysis of ‘Euskadi 2040’, the visioning initiative launched by the Basque regional government in collaboration with the research institute Orkestra. We articulate five main contributions of research institutes: facilitating the systemic character of the vision; incorporating academic action-oriented knowledge; supporting the divergence from traditional linear planning paradigms towards flexible learning-centred approaches to policy; promoting an interinstitutional and multi-agent shared discourse; and lastly, leveraging knowledge transfer within international networks.

Nuclear Physics Mid Term Plan at LNGS

The Istituto Nazionale di Fisica Nucleare—Laboratori Nazionali del Gran Sasso (LNGS) is one of the largest underground physics laboratory, a very peculiar environment suited for experiments in Astroparticle Physics, Nuclear Physics and Fundamental Symmetries. The newly established Bellotti Ion Beam facility represents a major advance in the possibilities of studying nuclear processes in an underground environment. A workshop was organized at LNGS in the framework of the Nuclear Physics Mid Term Plan in Italy, an initiative of the Nuclear Physics Division of the Instituto Nazionale di Fisica Nucleare to discuss the opportunities that will be possible to study in the near future by employing state-of-the-art detection systems. In this report, a detailed discussion of the outcome of the workshop is presented.

Challenging the Philosophical Axis Enactment in the Sustainability of Malioboro Street Vendors’ Relocation

In enacting its "Philosophical Axis", the Government of Yogyakarta forged a significant policy thattransformed its relations with community members especially street vendors. Under this policy,street vendors were relocated from their previous locations to sites known as Teras 1 and Teras 2Malioboro. Although the Operational Guidelines for the Implementation of the World HeritageConvention mandate the practice of sustainable development, street vendors—the economicbackbone of the Special Region of Yogyakarta—indicate that they have experienced a drastic loss ofincome due to accessibility issues. This research explores the impact of relocation on street vendors'income as well as short, medium, and long term plans for the new sites. Data were collected throughquestionnaires that were distributed to ninety respondents from Teras 1 and Teras 2, in-depthinterviews, and a review of the literature.

A 2D path-planning performance comparison of RRT and RRT* for unmanned ground vehicle

In recent years, path-planning has gained significant attention as mobile robots are used in various applications. Several factors determine the optimal path for a mobile robot, including accuracy, length of path, execution time, and turns. Among all planners, sampling-based planners such as rapidly exploring random trees (RRT) and rapidly exploring random trees-star (RRT*) are extensively used for mobile robots. The aim of this paper is the review and performance of these planners in terms of step size, execution time, and path length. All planners are implemented on the Jackal robot in a static environment cluttered with obstacles. Performance comparisons have shown that the reduction of step size results in exploring a greater number of nodes in both algorithms, increasing the probability of each extension succeeding. However, this causes the tree to become denser in both algorithms due to the more explored nodes. The RRT planner requires less execution time when the step size and iteration count are equal to RRT* planners. Moreover, performance plots of both algorithms show that RRT* provides an optimal and smooth path than RRT.

The Lived Experience of Parents of Children and Youth With Special Healthcare Needs on Public and Private Insurance: A Phenomenological Study.

The number of children and youth with special health care needs (CYSHCN) is steadily growing in the United States. There are significant differences between private and public health plans in terms of cost, adequacy, and parent satisfaction. The purpose of this study was to understand the experiences of parents with CYSHCN enrolled in public and private insurance with or without a nurse care coordinator. This study also sought to understand parents' experience of support. The primary practice setting was participants' choice of location. A qualitative descriptive design was used with 16 parents of children and young adults aged 2 to 21 years. Semistructured interviews were used, and Colaizzi's (1978) eight steps was the selected interpretive method. Five themes emerged for parents navigating their child's insurance in the presence or absence of a nurse care coordinator: (1) Struggle with Self-Preservation, (2) Abandonment and Isolation, (3) Self-Reliance and Advocacy, (4) Interdependence, and (5) Lifeline. These themes were also dependent on the type of insurance and sources of support available. Models centered on care coordination can also be used as a mechanism to guide nurse care coordinators in practice. Providing care coordination support could help lessen the caregiver burden especially while navigating public or private insurance. Results highlighted how insurance companies can make potential changes within the health plan infrastructure. Incorporating nursing care coordination activities not only results in health care savings for the health plan but also improved health outcomes for its enrollees.

Spatio-temporal modelling of referrals to outpatient respiratory clinics in the integrated care system of the Morecambe Bay area, England

BackgroundPromoting integrated care is a key goal of the NHS Long Term Plan to improve population respiratory health, yet there is limited data-driven evidence of its effectiveness. The Morecambe Bay Respiratory Network is an integrated care initiative operating in the North-West of England since 2017. A key target area has been reducing referrals to outpatient respiratory clinics by upskilling primary care teams. This study aims to explore space-time patterns in referrals from general practice in the Morecambe Bay area to evaluate the impact of the initiative.MethodsData on referrals to outpatient clinics and chronic respiratory disease patient counts between 2012-2020 were obtained from the Morecambe Bay Community Data Warehouse, a large store of routinely collected healthcare data. For analysis, the data is aggregated by year and small area geography. The methodology comprises of two parts. The first explores the issues that can arise when using routinely collected primary care data for space-time analysis and applies spatio-temporal conditional autoregressive modelling to adjust for data complexities. The second part models the rate of outpatient referral via a Poisson generalised linear mixed model that adjusts for changes in demographic factors and number of respiratory disease patients.ResultsThe first year of the Morecambe Bay Respiratory Network was not associated with a significant difference in referral rate. However, the second and third years saw significant reductions in areas that had received intervention, with full intervention associated with a 31.8% (95% CI 17.0-43.9) and 40.5% (95% CI 27.5-50.9) decrease in referral rate in 2018 and 2019, respectively.ConclusionsRoutinely collected data can be used to robustly evaluate key outcome measures of integrated care. The results demonstrate that effective integrated care has real potential to ease the burden on respiratory outpatient services by reducing the need for an onward referral. This is of great relevance given the current pressure on outpatient services globally, particularly long waiting lists following the COVID-19 pandemic and the need for more innovative models of care.

Modern Analyses of Macroeconomic Indices for Medium and Long Term Plans in Georgia

This paper analyzes the economic growth of Georgia through the lens of two key indicators: income/GDP per worker (representing productivity) and income/GDP per capita (representing prosperity). It emphasizes the importance of using Purchasing Power Parity (PPP) adjusted data to avoid misleading comparisons between countries with different price levels. The paper highlights three key stylized facts about Georgia's economy: Transformational Shock: Georgia's GDP per capita fell dramatically by 468% in less than ten years due to the collapse of the Soviet economic system. This is a unique event in modern economic history, with no other country experiencing such a sharp decline; Unstable Growth Rates: Unlike the U.S. which shows a relatively stable 2% annual growth rate over 150 years, Georgia's economic growth rates lack a clear trend and fluctuate significantly; Negative Correlation Between Cyclical Unemployment and GDP Gap: The cyclical unemployment rate and the GDP gap in Georgia are inversely correlated. As the unemployment rate falls below the natural rate of unemployment, the GDP gap widens, indicating potential overheating in the economy. The paper argues that existing models of economic growth, often based on developed economies with different macroeconomic realities, may not be suitable for analyzing Georgia's situation. It calls for the development of models that explicitly consider the unique features of Georgia's economy, including the transformational shock, unstable growth rates, and the relationship between unemployment and GDP. Overall, the paper raises important questions about the nature of economic growth in Georgia and the need for tailored models to understand its specific dynamics.

Transmission expansion planning in a wind-dominated power system: A closed-loop approach

The current paradigm for the transmission expansion planning (TEP) problem follows an open-loop (OL) approach. This approach first executes an accuracy-oriented forecasting method to predict the available wind power, demand, and spinning and non-spinning reserve (SR and NSR) requirements. Afterward, the TEP problem is solved based on these predictions. However, this OL model does not necessarily obtain a better expansion plan in terms of the real system cost (RSC) against the actual realization of wind and demand. This article contributes to the existing literature by developing a closed-loop (CL) strategy for the TEP problem using a cost-oriented prediction method. In this novel cost-oriented methodology, the RSC assesses the forecasting data quality rather than the statistical indices (accuracy-oriented). In this regard, a bilevel programming model is established to train the predicted data to minimize the system RSC. The upper level trains the predictors for wind power and SR/NSR requirements, while the two lower-level problems formulate the unit commitment (UC)-based TEP and the economic redispatch (ERD) problem. The bilevel programming that contains integer variables at both levels is solved by the reformulation and decomposition (R&D) technique. The numerical results on the IEEE 118-bus grid illustrate the cost-effective advantages of the CL-TEP method.

Monte Carlo Simulation and Scenario Analysis Based Limestone Quarry Production Planning

The key factor behind raw mix design in the cement factory is the appropriate production planning, resultingin high-quality raw material. Quarry managers usually come up with uncertainty-related raw materials due to variationsin chemical composition. These uncertainties required efficient planning in terms of useful insight into this problem.This research provides a detailed explanation of scenario analysis of raw materials used in cement manufacturing usingMonte Carlo simulation (MCS) and indices. Scenario analysis is used to predict the possibility of best, worst and mostlikely cases of raw material’s quality. Whereas, Monte Carlo simulation is used to evaluate the inherent uncertaintyassociated with chemical composition values in order to analyze the impact of truly unpredictable scenarios. Thepredictive results help in decisions related to production planning, raw mix design optimization and increasing theprobability of designing the best plan.

Риск-ориентированная онтологическая модель поддержки принятия управленческих решений в грузовом порту на основе многоуровневого целеполагания

In today's unstable market environment, transport logistics enterprises face the task of predicting possible risk situations in order to avoid them, as well as developing tools that allow them to form management decisions, evaluate the effectiveness of each of them and choose the most appropriate one, taking into account specific tasks and various influencing factors. Situations of failure to achieve the goals of a cargo port, as well as cases of failure by indicators to assess these goals of normative values, are considered as risks. The goals and indicators are outlined and described in the previously built Balanced Scorecard (MTSP). A set of links between goals and indicators of their assessment with risks at various levels of management is presented in the form of a developed multi-level hybrid logical-probabilistic (LV) risk model of a cargo port, as well as in detailed scenario models of this LV model. The integrated use of SSP and LV modeling technologies allowed us to build a general concept of multi-level goal setting, the main advantage of which lies in the detailed elaboration of the company's goals subordinate to the main strategic one, which allows, if necessary, to influence operational events and obtain a positive result in the longer term, in tactical and strategic plans. The ontological model contains all the information about the interaction of elements that affect the occurrence of risky events, and allows you to select options for getting out of a risky situation in accordance with various specified conditions. The results of queries to the risk-oriented ontological model are variants of management decisions aimed at reducing risks in the cargo port.

PROSPECTS FOR RUSSIAN-IRANIAN ENERGY COOPERATION

Due to the withdrawal of the United States under Republican President D. Trump in 2018 from the Joint Comprehensive Plan of Action (JCPOA) to resolve the Iranian nuclear crisis, non-Western vector of foreign policy of the Islamic Republic of Iran (IRI) (China, India, Russia, Turkey and other states) has strengthened. It became particularly apparent with the coming to power of a conservative president close to the Supreme Leader of Iran, Ebrahim (Ibrahim) Raisi. Seeking to escape the foreign policy isolation and financial and economic sanctions pressure created by the United States and its allies, Tehran is increasingly participating in the activities of major international entities such as the Shanghai Cooperation Organization (Iran became a full member of the Organization on July 4, 2023), the Eurasian Economic Union (Interim Free Trade Agreement is in force) and BRICS (a member of the organization since January 1, 2024).Thus, Iran declares itself as a successfully developing regional center of power. The article pays special attention to the development of energy (with Russia, Turkmenistan and Azerbaijan), transport and logistics projects (with Azerbaijan, a railway through Iran to Nakhichevan) with neighboring countries. Under President Raisi new gas and oil fields were discovered. In the future they will ensure greater production and exports. With Russia, Iran in the medium term plans to realize swap gas supplies to Iran through the territory of Turkmenistan, as well as to create a gas hub on the coast of Makran to export its own and Russian energy carriers to the countries of South and Southeast Asia. The government of I. Raisi pays special attention to the development of the Macran Free Economic Zone (FEZ) and the FEZ of Kish Island. At the same time, this is a significant territory not only in geo-economic, transportation and logistics, but also in military terms: the seaports of Chahbehar and Jask are geostrategic at the crossroads of energy communications of the Middle East and South (and further Southeast) Asia.

AI-Assisted Treatment Planning for Dental Implant Placement: Clinical vs AI-Generated Plans

ABSTRACT Background: Dental implant placement is a critical procedure in modern dentistry, requiring precise treatment planning to ensure successful outcomes. Traditionally, treatment planning has relied on the expertise of clinicians, but recent advancements in artificial intelligence (AI) have opened up the possibility of AI-assisted treatment planning Materials and Methods: Twenty patients requiring dental implant placement were included in this comparative study. For each patient, a clinical treatment plan was created by an experienced dentist, while an AI algorithm, trained on a dataset of implant placement cases, generated an alternative plan. Various parameters, including implant position, angulation, and depth, were compared between the two plans. Surgical templates were fabricated based on both plans to guide implant placement accurately. Results: The results of this study indicate that AI-generated treatment plans closely align with clinical plans in terms of implant positioning, angulation, and depth. Mean discrepancies of less than 1 mm and 2 degrees were observed for implant position and angulation, respectively, between the two planning methods. The AI-generated plans also showed a reduction in planning time, averaging 10 min compared to the clinical planning, which averaged 30 min per case. Additionally, the surgical templates based on AI-generated plans exhibited similar accuracy in implant placement as those based on clinical plans Conclusion: AI-assisted treatment planning for dental implant placement demonstrates promising results in terms of accuracy and efficiency.

Development of delivery indicators and delivery enablers for cardiovascular disease in the UK: a modified Delphi study

IntroductionStandards to define and measure quality in healthcare for cardiovascular disease risk reduction and secondary prevention are available, but there is a paucity of indicators that could serve as facilitators...

A Refined Neutrosophic Components into Subcomponents with Plausible Applications to Long Term Energy Planning Predominated by Renewable Energy

It is known that in the long-term planning of future energy supplies, in most countries, it is most likely that the energy mix will be predominated by renewable energy generation. While this feature of a predominating renewable energy mix appears too far fetched, such long term planning has been suggested, for instance, by Mark Jacobson from Stanford and also by John Blackburn. Here we consider two things, the first would be how to consider the long-term energy planning based on neutrosophic logic split into subcomponents.

Cone-beam computed tomography-guided online adaptive radiotherapy for pharyngeal cancer with whole neck irradiation: dose-volume histogram analysis between adapted and scheduled plans.

The present study aimed to evaluate whether an adapted plan with Ethos™ could be used for pharyngeal cancer. Ten patients with pharyngeal cancer who underwent chemoradiotherapy with available daily cone-beam computed tomography (CBCT) data were included. Simulated treatments were generated on the Ethos™ treatment emulator using CBCTs every four to five fractions for two plans: adapted and scheduled. The simulated treatments were divided into three groups: early (first-second week), middle (third-fourth week), and late (fifth-seventh week) periods. Dose-volume histogram parameters were compared for each period between the adapted and scheduled plans in terms of the planning target volume (PTV) (D98%, D95%, D50% and D2%), spinal cord (Dmax and D1cc), brainstem (Dmax) and ipsilateral and contralateral parotid glands (Dmedian and Dmean). The PTV D98%, D95% and D2% of the adapted plan were significantly higher than those of the scheduled plans in all periods, except for D98% in the late period. The adapted plan significantly reduced the spinal cord Dmax and D1cc compared with the scheduled plan in all periods. Ipsilateral and contralateral parotid glands Dmean of the adapted plan were lower than those of scheduled plan in the late period. In conclusion, the present study revealed that the adapted plans could maintain PTV coverage while reducing the doses to organs at risk in each period compared with scheduled plans.

2075 Systematic review of ‘Ageing well’ interventions to improve and maintain independent living for community housebound populations

Abstract Introduction The housebound population are growing in number, with a large proportion living rurally or in coastal areas, which increases the risks of isolation and health inequalities. This population are an under researched and underserved group (Public Health England, 2019). Being unable to leave the home is a factor for living in the poorest of health, which contributes to advancing levels of frailty, Curtis et al (2018). Considering the current focus of empowerment to ‘age well’ (NHS England Long Term Plan, 2019), a granular understanding of community focused ageing well interventions is the focus of this systematic review to empower clinicians to ‘make every contact count’ (NHS England 2020). Method A narrative evidence review of findings has been completed entitled ‘ageing well interventions to improve and maintain independent living for community housebound populations.’ The review was registered with PROSPERO international prospective register of systematic reviews (CRD 42022371047) and reported according to the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA). Data screening was undertaken by two reviewers at each stage to ensure accuracy, quality, and reliability. Results The results have identified key health interventions designed and delivered by community clinicians, including benefits of exercise, medication review, oral health, and health empowerment to improve outcomes for the housebound population. The results have outlined a total of twenty-nine outcome measures, which have been examined intrinsically and extrinsically to explore greatest impact for housebound health. Conclusion At the time of the Autumn conference, the research study will have completed the systematic review and be able to present findings to illustrate areas of intervention synthesized for the target population. Key to this will be understanding application, effectiveness, and generalizability for community delivery. The poster presentation will share progress of the wider study with opportunities to take part in the next Delphi panel stage.

1882 Treatment Escalation Plans (TEP): benefits in adult in-patient facilities

Abstract Introduction Treatment escalation plans (TEP) guide level of life sustaining therapeutic interventions that should occur for each patient admitted to hospital and can prevent inappropriate and undignified interventions. However, implementation of TEP in routine clinical practise has been ad hoc partly due to the paucity of literature on their benefits. Our aim was to systematically review the literature to ascertain the use and benefits of TEP in adults. Methods A systematic search for studies reporting TEP use were performed in the databases OVID Medline, Embase, Scopus and Web of Science. Search terms were ‘Treatment Escalation Plan’ Treatment Limitation, ‘Therapy Escalation’, ‘Escalation of Care’, ‘Palliative’, End of Life’, ‘Advanced Care Plan’. Exclusion criteria included studies prior to 2007, systematic reviews, case reports and letters. Results 468 records were retrieved, 117 duplicates removed, 351 records were screened. 302 were excluded by date or relevance. Of 49 eligible records, 39 were excluded by criteria or unavailability of full text articles. 10 Studies using case control and quality improvement methodology conducted between 2010-2022 involving 1614 patients were subject to a narrative review. 8 different TEP proformas were used. All studies reported an increase in TEP use across all clinical settings and after each PDSA intervention ranging from 78%-100%. TEP reduced the frequency of non-beneficial interventions and was associated with an average saving of £220 per patient. Conclusions TEP lead to more frequent and proactive discussions with patients on ceilings of care and provide clear guidance to clinical staff out of hours, facilitate patient handover over successive shifts and enable proactive discussions with critical care. We identified the need for TEP to be successfully implemented in a unified manner across all healthcare facilities in order to improve patient care, reduce the burden of non-beneficial interventions and align with the NHS Long Term Plan.

1942 Developing a Frailty SDEC Team at Salford Care Organisation

Abstract Introduction Frail older adults have longer waiting times in emergency departments (ED’s), are more likely to be admitted, and have longer lengths of stay1,2. The NHS Long Term Plan requires hospitals to provide an Acute Frailty Service (AFS) for at least 70 hours/week and complete a Clinical Frailty Score (CFS) within 30 minutes of arrival3. The plan advocates Same Day Emergency Care (SDEC) to reduce admission related harms and discharge patients in a timely way4. The introduction of an acute frailty CQUIN that requires prompt identification of frailty and initiation of CGA is another driver for the development of AFS5. Methods We created an acute frailty SDEC team including a frailty nurse, clinical-fellow, advanced clinical practitioners and GPs. The team was present in ED on weekdays between 9am-5pm with 1-2 team members on each shift. A Consultant Geriatrician provided advice and support. We developed loose frailty SDEC criteria: - Age >=65years with CFS>=5 and - NEWS<3 - Triage note suggests patient may not need hospital admission. Results Over a 4-month period, 262 patients were seen by the SDEC team. Age and CFS score for this population are shown in Graphs 1 and 2. Graph 1: Age of Patients Reviewed by SDEC Team Graph 2: CFS Score of Patients Reviewed by SDEC Team -74% were seen within 2 hours as demonstrated in Graph 3 Graph 3: Minutes patients waited to be seen (WTBS) from arrival at ED triage - 131(50%) of patients were discharged directly from ED. A further 25 patients were later discharged from EAU. Conclusions A frailty SDEC service results in early identification of frailty, timely assessment in ED and a high likelihood of discharge (60%) directly from ED or EAU rather than being admitted to an inpatient ward. Implementation of a 7-day service would only serve to increase these figures.