Senior House Research Articles

Geospatial Mapping to Target Injury Prevention for Older Adult Ground-Level Falls: A Feasibility Study.

Trauma centers target injury prevention efforts based on trauma registry and local epidemiological data. Identifying geographic patterns of injury through geospatial mapping has emerged as a technology to help identify at-risk individuals. Yet, the feasibility of using spatial analysis to target injury prevention efforts remains unknown. This study aims to demonstrate the use of geospatial mapping of older adult ground-level falls to target injury prevention efforts. This retrospective cohort analysis of ground-level falls among older adults was conducted from 2017 to 2020 at a Level I trauma center and safety net hospital. Trauma admissions, U.S. census median income, Hispanic percentage, and population density by zip codes were combined to create choropleth and heat maps to identify injury hot spots to target fall prevention classes. A total of 5,629 patients were reviewed, of which 3,002 (53%) were fall cases. Low-level falls (<10 ft) accounted for 2,224 cases; 1,449 were among older adults centered around the study hospital. Ground-level falls accounted for 1,663 patients, of whom 1,182 were older adults clustering around senior housing, assisted living facilities, nursing homes, and rehabilitation centers. As a result, our fall prevention classes are now targeted at these newly identified locations. Geospatial analysis provided powerful visualization of fall injury locations to target our fall prevention efforts. Geospatial analysis is a feasible tool for trauma centers to guide injury prevention strategies that effectively target the populations most in need.

24 Associations Between Positive Psychological Factors and Neurocognitive Functioning in Older Adults

Objective:Psychological wellness and strong cognitive skills are both important to successful aging. Although there are well-established relationships between psychiatric illness (e.g., depression, anxiety, PTSD) and cognitive dysfunction, few studies have focused on the relationships between positive psychological factors and neurocognitive function in older adults. Our goal was to explore associations between these two sets of measures in older adults.Participants and Methods:Participants (n=111) were part of a longitudinal study of biopsychosocial functioning in independently living older adult residents of a Continuing Care Senior Housing Community. Participants were administered a cognitive screening test (Montreal Cognitive Assessment; MoCA), a comprehensive neuropsychological battery, and a set of published self-report scales measuring positive emotional and psychological function. Neuropsychological scores were appropriately normed, and composite scores were calculated for the following domains: language (Boston Naming Test, Delis-Kaplan Executive Function System [D-KEFS] Verbal Fluency), attention/working memory (Wechsler Adult Intelligence Scale-IV [WAIS-IV] Digit Span, DKEFS Visual Scanning), learning and delayed recall (Brief Visuospatial Memory Test-Revised, Hopkins Verbal Learning Test-Revised), processing speed (WAIS-IV Coding, D-KEFS Trails Number and Letter Sequencing, D-KEFS Color-Word Interference Test Color and Word Naming), and executive function (D-KEFS Color-Word Inhibition and Inhibition/Switching, DKEFS Letter/Number Switching). Self-Report scales included the Perceived Stress Scale, Center for Epidemiological Studies in Depression Scale, Emotional Support Scale, Connor-Davidson Resilience Scale, Coping Humor and Self-Efficacy Scales, Personal Mastery Scale, Meaning in Life Scale, Self-Rated Successful Aging, Satisfaction with Life, Cognitive Failures Questionnaire, and Lifetime Orientation Test-Revised. Due to the large number of psychological functioning measures, dimension reduction was undertaken via principal component analysis, resulting in a two-factor solution. Bivariate Pearson correlations were then computed between the two factor scores and each neurocognitive variable.Results:Factor 1 consisted of variables reflecting Positive Subjective Functioning. A higher score on Factor 1 (indicating higher self-rating of successful aging, fewer perceived cognitive failures, fewer reported depressive symptoms, less perceived stress/anxiety, more perceived emotional support, more satisfaction with life, more meaningfulness in life, and more search for meaning in life) was associated with better attention/working memory (r=0.226, p=0.049) and executive function (r=0.242, p=0.035). Factor 2 consisted of variables that reflected Positive Coping Skills. A higher score on Factor 2 (indicating more happiness, higher optimism, greater resilience, higher sense of personal mastery, more use of humor as a coping strategy, and greater coping self-efficacy) was associated with better performance on tests of language (r=0.325, p=0.004), learning (r=0.313, p=0.006) and delayed recall (r=0.241, p=0.035) of visual and verbal information, and better MoCA performance (r=0.440, p&lt;0.001). Neither factor was associated with processing speed.Conclusions:Higher levels of subjective functioning and positive outlook/coping skills were associated with better neuropsychological performance. Given that late life is a time of risk for cognitive decline, future research should consider the influence of positive psychological functioning on neurocognitive outcomes and vice versa, as these relationships may have neurobiological and therapeutic implications for overall function in later life.

Quality of Counseling About Lifestyle Modifications and Complications of Hypertensive Patients, Sudan

Hypertension is a common chronic disease and an important public health problem. Effective hypertension control depends on patients being aware of the necessary lifestyle modifications. This study aimed to assess the quality of counseling received by hypertensive patients, the influence of blood pressure control and complications of hypertension. This cross-sectional study was conducted on hypertensive patients attending a private medical facility, a governmental facility and a PHC (Primary Health Care) center in Sudan. The patients were randomly selected, and their waist circumference, height and weight were recorded. The participants received counseling from family physicians and SHOs (Senior House Officers) about diet, mental relaxation, weight loss, exercise, smoking, and alcohol. The follow-up doctor vs. counseling showed a significant difference in counseling about diet, salt, fat intake, and smoking. The quality of counseling depended on the doctor rather than the follow-up location. The quality of counseling offered to hypertensive patients depends on the doctor rather than the location; almost half of the participants had to follow up with SHOs, including half of the participants with complications, and only a quarter received counseling about complications. For hypertensive patients, the quality of counseling depends on the doctor rather than the location. Recommendations include prioritizing lifestyle modifications and ensuring doctors are sensitive and aware of their counseling tactics with patients.

Quality of Life among Low-Income Older Residents in Subsidized Senior Housing: Rural vs. Suburban Comparisons

Older adults living in subsidized senior housing tend to be at risk for poor psychological well-being related to their advanced age and low income. This study aims to explore multilevel factors affecting perceived quality of life (QoL) among non-urban subsidized senior housing residents and to compare these factors between rural and suburban communities. Community/residential-level data were collected from the interviews with residential service coordinators (RSC) of five subsidized senior housing communities in the New England region: two rural and three suburban communities. Individual- and interpersonal-level data came from the survey with 82 residents. A mixed-methods approach was utilized. We used thematic content analyses for the interview data and multivariate ordered logit regression for the survey data. Our results showed that rural residence was positively associated with QoL (OR = 4.913, p<.01) even after controlling for all the individual-, interpersonal-, and community/residential-level factors. From RSCs’ perspectives, four main themes emerged, which could potentially contribute to better QoL among senior housing residents: access to services, social spaces for residents, inequitable connections to community resources, and social engagements among senior housing residents and with RSCs. Our findings contribute to the development of strategies to improve QoL among older adults living in rural/non-metropolitan subsidized senior housing.

Assessment of tympanic membrane perforation size using ImageJ software by ENT clinicians of different grades.

To compare visual estimation versus ImageJ calculation of tympanic membrane perforation size in the paediatric population between clinicians of different experience. Five images of tympanic membrane perforations in children, captured using an otoendoscope, were selected. The gold standard was the ImageJ results by one consultant otologist. Consultants, registrars and Senior House Officers or equivalent were asked to visually estimate and calculate the perforation size using ImageJ software. The mean difference in variation from gold standard between visual estimation and ImageJ calculation was 12.16 per cent, 95 per cent CI (10.55, 13.78) p < 0.05, with ImageJ providing a more accurate estimation of perforation. Registrars were significantly more accurate at visual estimation than senior house officers. There was no statistically significant difference in ImageJ results between the different grades. Using ImageJ software is more accurate at estimating tympanic membrane perforation size than visual assessment for all ENT clinicians regardless of experience.

The Increasing Investment of Senior Housing for Chinese Life Insurance Companies: Reasons and Motivations

In China, there has been a notable growth in the practice of life insurance companies investing in senior housing projects, which has gained significant popularity. 8 out of 10 largest life insurance businesses are actively engaged in the life insurance market. The senior housing firm with the highest market share is owned by a life insurance company, which has successfully sold 190,000 products through its investments in senior housing. This article seeks to present the business model and elucidate the underlying rationales. A thorough review of the current body of literature is conducted, followed by the use of the case study methodology. This study concluded that life insurance products, such as the happiness guide, play a crucial role in the economic model of life insurance and senior housing. The reasons were categorized into internal and external factors. The expansion of liabilities is an internal factor that is influenced by the leverage effect of a senior housing projects. Moreover, the features of insurance capital exhibit compatibility with the investment of senior housing. Additionally, external factors such as a poor income replacement rate and insufficient availability of high-quality senior housing might also contribute to the condition.

Post-Acute and Long-Term Care in Senior Housing

Post-Acute and Long-Term Care in Senior Housing

고령친화형 서비스 융합의 시니어 주거단지 개발 방안 연구

This study is to find ways to respond to Korea’s low-growth and aging issues with suggesting a future residential complex model through advanced domestic and international cases. The 50+ community shows a new vision for building a preemptive housing system, spreading private-led service supply, and further creating an “Aging In Place” environment.&#x0D; Active seniors in their 50s and 60s are the generations not only with relatively large assets, but also with poor economic and residential conditions due to divorce, business failure, and unemployment. It is also necessary to develop community-based social support service system to support housing, stable income and leisure activities, and create premium housing services to fulfill their unmet needs and trendy lifestyles especially for active seniors with high income.&#x0D; In the United States, the senior housing business is expanding centering on large private construction companies’ franchises. In addition, various service infrastructures, such as 50+ community, independent living, assisted living, nursing home, and dementia care home, are built together in a huge complex according to the consumer’s requirements. In Europe, senior citizens live in flat, apartments, condos, share homes, or houses and use community-based social welfare service and programs. The famous European retirement communities are usually surrounded by the beautiful natural environment with luxurious resort facilities.&#x0D; The 50 plus community is a preemptive model that can contribute to the creation of the “Aging In Place” environment in Korea. It is also necessary to develop a new ageing-friendly residential complex model for encouraging investments of the private sectors. A private-led 50+ community model is to be differentiated from the public-centered model which mainly focus on supporting daily living services for super-aged, low-income, and disabled seniors. The preemptive new model may be triggering a new senior housing business and solve the social problems in this super-aged society.

An exploration of the use of accessory dwelling units for senior housing in Honolulu

The island of Oahu (Honolulu County, Hawai’i) is facing a shortage of housing for its growing senior population. The construction of accessory dwelling units (ADUs), or small, second homes built on the same lot. for senior housing may be a possible solution. A qualitative document review was utilized to examine the existing Honolulu ADU cost reduction for those wishing to build an ADU on their properties for the purposes of senior housing. There were several publications and articles found through the search. From these articles, four major themes emerged: tax breaks, financing options, green building, and sharing of utilities. These themes led to a secondary level document review and analysis of each of these themes.

Prevalence of Loneliness in Older Adults: A Scoping Review

Objectives. To review the prevalence of loneliness (during/after COVID-19) in older people. Design. Scoping review using Medline and PsycInfo for worldwide prevalence estimates (white published literature search) and Google for prevalence data inside the Euregio Meuse-Rhine (grey literature). Setting. Worldwide prevalence estimates and a focus on the Euregio Meuse-Rhine. Participants. Papers published between 2016 and 2022 and a mean age of minimum of 65 years. Measurements. Prevalence estimates for older people. Results. The white literature search yielded 37 articles. Before the onset of the COVID-19 pandemic, loneliness estimates were the highest in Nigeria (46%) and the lowest in Australia (5%) (mean prevalence was 25.6%). Loneliness was reported to be higher in specific populations, for example, people living in specific communities such as senior housing communities or with impairments, than in the general population, with a mean prevalence estimate of 47.8%. During COVID-19, the prevalence of loneliness was higher than that before the pandemic: we observed a mean prevalence of 39.4%, in comparison to 25.6 before COVID-19. The grey literature search showed that, compared to Belgium and the Netherlands (13.5% and 36.5%, respectively), loneliness estimates were the lowest in Germany, with a mean prevalence of 7.7%. Conclusion. Large international differences in the prevalence of loneliness were observed between countries and populations studied. Several hypotheses could explain such differences, including sociocultural or historical-political characteristics. Without surprise, the pandemic and associated measures were linked to a higher level of loneliness. Furthermore, recommendations for addressing loneliness, including interventions, are discussed.

67 Audit of discharge summaries on a geriatric ward against the Health Information and Quality Authority (HIQA) National Standard

Abstract Background Discharge summaries are integral for safe transition of patient care. Complete, precise and succinct documentation can ensure improved quality of care and patient safety. Methods Retrospective data were collected from e-discharge summaries that were generated over a 7-month period from June-Dec 2022. A total of 20 samples were selected at random and assessed against the HIQA National Standard. The samples were compared to the physical medical records to countercheck if relevant information were present or omitted. There was a total of 78 outcomes measured as per the national standard. Results There were 8 (40%) discharge summaries with the complete clinical courses, in that they contained the main complaint, relevant clinical findings, relevant investigations results and the complete treatment courses. There were 4 (20%) summaries that had omitted documentation of inpatient complications or adverse events and 8 (40%) summaries had omissions present on medication prescriptions. There were 5 (25%) summaries whereby the list of stopped medications and the reasons for stopping the respective medications were omitted. There were 5 (25%) summaries with incomplete documentation of future plans. Only 4 (20%) discharge summaries had all the relevant information present. Conclusion Efforts to implement E-prescribing and electronic health records should be prioritised. The Irish Medical Council plans to introduce Entrustable Professional Activities (EPA), which are essential tasks that a trainee can be trusted to perform without direct supervision, once sufficient competence has been demonstrated. An entire EPA unit is dedicated to competent patient handover and discharge. A Discharge Summary Flowchart which highlights the inclusion of all the essential components of a complete discharge summary was introduced as a guide for the team. Finally, there is an ongoing continuous audit by Senior House Officers and Interns to assess the quality of discharge summaries after the recommendations have been implemented.

O.2.1-5 Knowledge, use and confidence in physical activity guidelines and assessment in recently graduated doctors from Irish medical schools: a cross sectional survey

Abstract Purpose Approximately 54% of the adult population in Ireland do not meet National Physical Activity Guidelines. Doctors play a key role in supporting people to be more active but may lack knowledge, skills and confidence to promote physical activity. The aim of this study was to explore knowledge and confidence in relation to physical activity counselling in recent medical graduates in Ireland. Methods Medical doctors who graduated from Irish medical programmes in the past 5 years and currently had patient contact were asked to complete an online survey between April and November 2022. The survey was shared with medical graduates through social media, alumni groups, and relevant professional and social networks. The survey included a minimal number of questions about participant demographics and education, questions relating to participants' knowledge and confidence of physical activity guidelines and counselling, and questions relating to education and training on physical activity. The responses were downloaded to Excel and data such as mean, standard deviation, frequency and percentage, were analyzed to summarize participant responses. Results Among the 95 responses, the majority were from graduates of Direct Entry Medicine Programmes who were currently working as Senior House Officers in either Ireland or Australia. Key findings indicated that 76% of participants were unaware of the Irish Physical Activity Guidelines and 60.76% are unaware of the Making Every Contact Count Framework. The majority wanted to receive training on physical activity at undergraduate level (73%) and postgraduate level (61%). With regards to physical activity knowledge for counselling, a majority of responders rated their knowledge between 5,6 and 7 out of 10. Similarly, a majority of responders rated their confidence in prescribing between 4,5, and 6 out of 10 (1 being not confident and 10 being extremely confident). The top three subjects participants wanted training on were: Physical Activity Guidelines, Counselling, and Assessment. Conclusions Findings indicate a gap in the teaching and assessment of physical activity in undergraduate medical curricula in Ireland. However, there is demand among recent graduates for training on physical activity. Future studies should be done among a larger sample in order to strengthen confidence in our findings.

Surgical Training in the United Kingdom's National Health Service: The Challenges for International Medical Graduates.

The UK's National Health Service (NHS) is a hub that trainees from all over the world want to join. However, there are many challenges for International Medical Graduates (IMGs). The aim of this study is to raise awareness of these challenges and to attempt to identify areas for improvement in the surgical training experience for international graduates wishing to join the NHS and obtain a National Training Number (NTN). A 33-question survey was designed and distributed to the surgical community via The Upper Gastrointestinal Surgery Society (TUGSS) and social media. Eighty-fiverespondents, IMGs from 25 countries, participated. The results showed that 43.5% of doctors had a Master's degree (MSc). Most IMGs joined as locally employed doctors at the senior house officer or registrar level. They all faced many challenges in the UK, including difficulties finding a job in the NHS, obtaining an NTN, and adapting to the differences between UK surgical practice and their home country. More than 50% of doctors did not have a named educational/clinical supervisor, and 63.2% of them felt that the supervisor helped them to become more familiar with the system. The support doctors received from the human resources department of the hospital they joined was poor. In addition, more than half of the IMGs changed their career plans after joining the NHS (56.4%) and would like to stay in the UK (52.9%). The majority of them (43.9%) plan to obtain an NTN. This study showed that there is a need to support international doctors who wish to start or continue their training in the UK. Furthermore, IMGs should expect to face several challenges when applying to work in the UK NHS.

385 Neurovascular Status Documentation in Fracture Manipulation

Abstract Aim To improve standards of documentation of neurovascular status before and following manipulation in keeping with standards set by the British Orthopaedic Association (BOAST guidelines: Peripheral Nerve Injury1). Method At a major trauma centre, we retrospectively collected data on thirty orthopaedic patients who underwent fracture manipulation in October 2022. Data included documentation of sensory, motor and vascular neurovascular status, prior and following manipulation. Posters were displayed in the emergency and orthopaedic departments on adequate neurovascular documentation, and an autotext proposed to aid senior house officers with electronic documentation. Prospective data was then collected on the subsequent thirty patients. Results Prior to manipulation, sensory neurological status was documented in 40% of patients and motor neurological status in 43.3% in patients. Post-manipulation documentation was 10% and 13.3% respectively. Documentation of vascular status prior to and post-manipulation was 40% and 16.7%. Following our intervention, pre-manipulation documentation of sensory and motor neurological status was 60% and 63.3%; post-manipulation was 20% and 13.3%. Documentation of vascular status prior and post-manipulation was 70% and 20%. Conclusions Following our intervention, there was an improvement in documentation of both sensory and motor neurological status prior to manipulation, however there was no change in motor status post-manipulation. The intervention used may not provide a sustainable improvement in documentation. Use of a designed electronic form, which can be accessed easily for electronic documentation, may improve results further.

1076 Staff Perceptions on Electronic Patient List Management: Introducing the General Surgery Care Teams to Improve Patient Safety

Abstract Aim Electronic patient lists are widely used across NHS England and commonly rely on staff manually updating lists to guide inpatient ward-rounds, creating potential for human errors. Locally, lists are extracted from Electronic Patient Record (EPR), whereby doctors are responsible for ‘coding’ patients under ‘general surgeon’ at admission. Errors in this process lead to “missed” patients, raising concerns for patient safety. This study aimed to assess staff perceptions surrounding this system to help implement the new EPR General Surgery Care Team. Method Perceptions were analysed using an online anonymous questionnaire, distributed via a messaging group. Questions were categorised into ‘ease of use’, ‘time-efficiency’ and ‘safety’, and assessed using a Likert Scale (1-5). Open questions screened for list-related examples of poor patient care and areas for improvement. Results Twelve responses were analysed: 7 (58.3%) Foundation Year 1, 4 (33.4%) Senior House Officers and 1 (8.3%) Registrar. Eleven (91.7%) responses reported the system to be inefficient and 7/12 (58.3%) difficult to use (scoring Likert 4-5). 100% believed the system disturbed patient care (Likert 3-5), describing it as “complicated”, “time-consuming” and “messy to use”. This “compromises patient safety” and “increases junior workload”. Nine (75%) responses identified specific examples where the system directly affected care, including patients “missed” from ward-rounds, delayed management, and adverse outcomes. Conclusions The ‘old’ list management system was complex and slow to use, directly compromising patient care. Further qualitative data is required to continue improving the General Surgery Care Team List, implemented using this feedback, to optimise patient safety.

804 Audit of Hand-Written Consent Form Documentation for Skin Lesion Excisions in the Plastic Surgery Procedure Room

Abstract Aim To audit the hand-written consent forms for elective excision of skin lesions in the Procedure Room. Method The notes and consent forms from 11 Procedure Room sessions were analysed. The total number of notes reviewed were 24. Our audit standards focused on the consenter and the completion of sections of the audit form. There are no standard guidelines for the complications of skin lesion excision, therefore a consensus from the general consultant body was used. Results Our patient demographic mostly consisted of male patients (15, 63%) with a mean age of 50 (range 17 – 75). 83% of the procedures required no reconstruction, 8% were biopsies and 8% required a full thickness skin graft (FTSG). 75% of the consenting clinicians were Registrars. The rest were Senior House Officers. All the consenters documented their job title, signed and dated their signature. All were trained in consenting and each consenter performed the procedure. 100% of clinicians used the correct consent form, documented the proposed procedure, clearly documented the site and risks and placed a label on every page. 83% completed the ‘intended benefits’ section. 58% wrote the procedure name in full. Every clinician documented bleeding and infection as a risk factor. 54% pain, 75% re-excision of margins, 71% recurrence and wound breakdown, 96% scarring, 46% injury to surrounding structures and 0% anaesthetic risk. All patients who received a FTSG, had graft loss documented as a risk. Conclusions The quality of hand-written consent forms is user dependent. A pre-filled consent form is proposed to increase compliance.

792 Assessing the Frequency of Daily Patient Reviews in a Local Orthopaedic Department

Abstract Aim To investigate the frequency at which patients admitted under a local orthopaedic department are having daily reviews by various teams, and to assess the level of clinical seniority that saw these patients. Method Patients primarily under the care of the orthopaedic department were assessed over a 10-day period in two different time frames across November 2022. These included all male and female inpatients presenting with any condition. Data was collected manually by going through the patient notes and the most senior orthopaedic doctor who saw the patient on that day was recorded as the main reviewer. Results 73 patients with an average age of 76.0 years were included. Overall, patients were seen by orthopaedics on 58.4% of the days they were in hospital. 21.2% of these were done with a consultant present, 10.4% by a registrar, 17.6% by a senior house officer, and a foundation doctor in 9.2% of occasions. Outcomes were worse over the weekends, where 56.8% of inpatients did not get reviewed at all. There were also considerable differences between the various teams, reviewing their patients from 32.9% to 69.1% of the time. Conclusions Patients should ideally be reviewed daily as not only does it affect patient flow but also ensures vulnerable individuals are getting the timely care that they need. This pilot study showed a considerable lack in the number of daily reviews, with some patients not being seen for several days. Therefore, better organisation and accountability of the workforce is required to reach higher standards of care.

971 Audit of Consent Documentation for Emergency Hand Surgery in the Ambulatory Procedure Unit

Abstract Aim To audit the handwritten consent forms for emergency hand surgery in the unit. Method The notes and consent forms from a selection of 8 days were analysed (total 25). Our audit standards focused on the consenter and the completion of sections on the consent form. There are no published standards for hand surgery complications, therefore a consensus from the general consultant body was used. Results 80% of our patients were male with a mean age of 48 (range 20 – 71). 60% were tendon repairs, 20% debridement, 20% digital nerve repairs, 12% nail-bed repairs, 12% excision of lesion, 8% terminalisation, 8% incision and drainage, 8% manipulation under anaesthesia, 4% carpal tunnel decompression and 4% plating of fracture. 68% of the consenting clinicians were Registrars, 16% Senior House Officers and 8% Consultants (8% illegible). 92% of the consenters performed the procedure. All the consenters signed and dated their signature and were trained in consenting. 88% documented their job title. 100% of clinicians used the correct consent form, documented the proposed procedure, site and risks. 92% completed the ‘intended benefits’ section, 96% wrote the procedure name in full and 88% placed a label on every page. Every clinician documented bleeding and infection as a risk factor. 92% documented complex regional pain syndrome, 68% stiffness, 48% wound dehiscence, 40% delayed healing, 84% scarring, 36% injury to surrounding structures and 56% further procedures. Conclusions The quality of hand-written consent forms is user dependent. A pre-filled consent form and discussion in clinical governance is proposed to increase compliance.

SP9.7 A Quality Improvement Project to Optimise the Emergency Department to General Surgery Referral Process

Abstract Introduction Optimising the process of referrals from the Emergency Department (ED) can improve patient care. Currently, referrals to General Surgery (GS) are accepted by the Senior House Officer (SHO) and Registrar (SpR) on-call. This leads to two ongoing lists of referrals and the possibility of patients being missed. ED uses symphony to track referrals, but GS does not currently use this system. Method A survey was sent to all GS SHOs/SpRs to assess the process and tracking of referrals. Symphony was implemented as a virtual system to streamline the referral process. A repeat survey to evaluate the effectiveness of this intervention was conducted 1 month later. Results In the pre-intervention survey, 36% of doctors used a paper list to track referrals. The referral system was rated on average as 2.6/5 (1 – terrible, 5 - excellent). 50% reported feeling that patient safety had been compromised &amp;gt;5 times in the last month due to miscommunication between ED and GS. In the post-intervention survey, there was a significant decrease in the number of times patient safety was reported as being compromised in the last month (p=0.047). Pre-intervention, the theme of the majority of suggestions for improvement included an electronic system for tracking referrals, whereas post-intervention, most suggestions were about the history/ investigations done for each referral. Conclusion The use of the same system, symphony, by ED and GS has improved patient safety, although the Symphony program itself as well as the quality of referrals could be improved.

Effects of Cuff Size on the Accuracy of Blood Pressure Readings

Clinical practice guidelines recommend selecting an appropriately sized cuff based on mid-arm circumference prior to measuring blood pressure (BP). To our knowledge, the effect of miscuffing on BP measurement when using an automated BP device has not been quantified. To determine the effect of using a regular BP cuff vs an appropriately sized BP cuff on automated BP readings. This randomized crossover trial of community-dwelling adults with a wide range of mid-arm circumferences took place between March 16 and October 25, 2021, in Baltimore, Maryland. Participants were recruited via BP screening events at a public food market and a senior housing facility, targeted mailings to prior research participants, placement of study brochures in hypertension clinics at Johns Hopkins University, and referrals from physicians providing hypertension care to adults. Participants underwent 4 sets of triplicate BP measurements, with the initial 3 sets using an appropriate, too-small, or too-large BP cuff in random order; the fourth set of triplicate measurements was always completed with an appropriate BP cuff. The primary outcome was the difference in mean BP when measured with a regular BP cuff compared with an appropriate BP cuff. The secondary outcome was the difference in BP when using too-small or too-large BP cuffs vs an appropriate BP cuff across all cuff sizes. Results were also stratified by systolic BP (≥130 mm Hg vs <130 mm Hg) and body mass index (calculated as weight in kilograms divided by height in meters squared; ≥30 vs <30). A total of 195 adults (mean [SD] age, 54 [16] years; 67 [34%] male; 132 [68%] Black; 100 [51%] with hypertension) were randomized for inclusion. Among individuals requiring a small BP cuff, use of a regular BP cuff resulted in a statistically significant lower BP reading (mean systolic BP difference, -3.6 [95% CI, -5.6 to -1.7] mm Hg). In contrast, among individuals requiring a large or extra-large BP cuff, use of a regular BP cuff resulted in a statistically significant higher BP reading (mean systolic BP difference, 4.8 [95% CI, 3.0-6.6] mm Hg and 19.5 [95% CI, 16.1-22.9] mm Hg, respectively). For the secondary outcome, BP differences with overcuffing and undercuffing by 1 and 2 cuff sizes were greater among those requiring larger BP cuffs. The results were consistent in stratified analyses by systolic BP and body mass index. In this randomized crossover trial, miscuffing resulted in strikingly inaccurate BP measurements. This is particularly concerning for settings where 1 regular BP cuff size is routinely used in all individuals, regardless of arm size. A renewed emphasis on individualized BP cuff selection is warranted. ClinicalTrials.gov Identifier: NCT04610775.