Posters

From Documentation to Discharge: Standardising a nursing proforma to improve patient flow and support patient centred care Introduction: High quality nursing documentation is essential for multidisciplinary team (MDT) decision making, discharge planning and supporting patient flow. Within an Older Persons Unit, inconsistent documentation and structure created challenges accessing key clinical information, delaying care coordination. A Quality Improvement Project (QIP) introduced a standardised SmartPhrase aligned with Comprehensive Geriatric Assessment (CGA) domains to improve documentation

Introduction Frailty assessment is increasingly embedded within acute care pathways and informs escalation decisions, peri-operative risk stratification and orthogeriatric referral. Although the Clinical Frailty Scale (CFS) is widely used, it remains uncertain whether different clinical teams assign the same score to the same patient during routine care. Variation in CFS documentation and scoring was suspected between the Emergency Department (ED) and Major Trauma Service (MTS). We aimed to evaluate documentation, inter-team agreement and the potential impact of score discordance on trauma

Introduction Fragility fractures are associated with increased morbidity and mortality in the elderly population. The National Osteoporosis Guideline Group (NOGG) guidance recommends fracture risk assessment (FRAX), blood tests, and DEXA scan where indicated for patients admitted with falls. This audit evaluates whether formal bone health assessments were consistently completed and documented following admission to the Older People’s Medicine (OPM) wards at Norfolk and Norwich University Hospital, risking missed opportunities for fracture prevention in a high-risk population. Methods Patients

Introduction Fragility fractures are associated with substantial morbidity and mortality in older people. National Osteoporosis Guideline Group (NOGG) guidance recommends formal fracture-risk assessment in patients >50 or postmenopausal with risk factors for fragility fracture, including frailty. All patients admitted to the Older People’s Medicine (OPM) wards included in this audit had documented frailty (Clinical Frailty Scale ≥ 6). This closed-loop audit aimed to improve fracture-risk and wider bone-health assessment and documentation in this high-risk population. Methods Patients admitted

Rapid Assessment and Triage (RAT) is the assessment of ‘majors’ type patients in the Emergency Department. Frailty expertise early in a patient journey ensures timely assessment and can reduce hospital length of stay. On 11 non-consecutive days in March 2026, 8-5pm, a Frailty ACP was located in RAT in our type 1 Emergency Department. Patients were included if aged ≥75 years with a CFS score of ≥5 presenting with a frailly syndrome. Exclusion criteria included patients with trauma, potential long bone injuries or surgical presentations. After RAT by either a Frailty ACP or ED, patients were

Introduction Communication between clinical teams, patients and their families is an essential aspect of patient-centered care. This is particularly important in geriatric medicine where our patients may be less able to update their families themselves. A friends and family survey on the complex-care ward highlighted shortcomings in the family update process. Method Baseline data was collected and analyzed from the notes of 33 patients on the complex-care ward, including the number of documented family updates per patient and whether an update occurred within 48 hours of arrival to the ward

Introduction The United Kingdom (UK) has an ageing population, with adults aged over 65 years representing the highest users of health care services, contributing to increasing pressure on hospitals and Emergency Departments (EDs), including prolonged waiting times and capacity challenges. In response, there has been development of Virtual Frailty Wards (VFWs). However, there remains a gap in education for care home staff, who are responsible for initiating ambulance callouts, contributing to avoidable ED attendances. Methods A quantitative design was utilised, a retrospective review of ED

Introduction East Sussex is an area of the UK with a comparatively higher proportion of the older population and high prevalence of frailty. Polypharmacy is becoming increasingly common in the older population and may contribute to hospital admissions through adverse drug effects. We aimed to identify the most common potentially inappropriate medications on admission and evaluate whether appropriate medications review and deprescribing occurred. Method A retrospective study was conducted with 310 patients aged ≥65 years admitted to our acute frailty ward over a 3-month period. Admissions and

Introduction Limited alternatives to hospital care and fragmented frailty services led to unwarranted variation and poor outcomes for older people. Half of emergency department (ED) patients could potentially have been managed through frailty same-day emergency (FSDEC) care; average time in ED for over 85s was eight hours; and the Urgent Community Response (UCR) two-hour rate deteriorated to 40%. A three-year continuous improvement programme aimed to develop an integrated frailty crisis pathway, improve access to Comprehensive Geriatric Assessment (CGA) and reduce unnecessary hospital

Introduction Urgent Community Response (UCR) and Virtual Frailty Ward (VFW) services provide acute care at home for older adults living with frailty. Increasing referrals for urgent catheter care, including blocked catheters and urinary retention, placed pressure on clinical capacity and challenged delivery of the national two-hour response standard. To address this, Berkshire Healthcare NHS Foundation Trust UCR developed a governance-approved pathway enabling experienced Band 4 support workers to undertake uncomplicated urethral catheterisation under the Trust delegation policy, following

Introduction Falls in the elderly over the age of 65 are common, and the prevalence increases with age. Current NICE guidance on managing falls involving head injury in patients receiving anticoagulation can be challenging to interpret. Combined with increasing pressures on ambulance services and emergency departments (EDs), this prompted development of a collaborative admission avoidance pathway. Methods A joint head injury pathway was developed by the Royal Berkshire NHS Foundation Trust (acute hospital), Berkshire Healthcare NHS Foundation Trust (community physical and mental health

Background: Delirium is a common, under-recognised and under-diagnosed condition in hospital, which can be assessed by the ‘4-A’s’ Test (4AT), as recommended by NICE. The 4AT test requires minimal training and is used broadly, including in patients with reduced consciousness and drowsiness. NICE considers the 4AT to be practical and accurate in most clinical settings. Recent research supports its performance; one 2026 meta-analysis by Keane et al., demonstrated a pooled sensitivity of 88% and specificity of 79% for detecting delirium in patients with dementia. This QIP aimed to increase 4AT

Introduction Multimorbidity, the co-occurrence of two or more chronic conditions, is highly prevalent among older adults and is closely linked to functional decline, polypharmacy, and heightened healthcare use. However, its specific impact on early 30-day hospital readmission rates in older adults ( 65 years old) has not been synthesized with recent literature (2022 onwards). This review evaluates the association between multimorbidity and 30-day readmission in older adults, investigating whether risk scales proportionally with condition count or overall burden. Methods A systematic search of

Introduction Direct-acting oral anticoagulants (DOACs) have seen a recent increase in numbers prescribed, due to effective prevention of strokes and embolic events in non-valvular atrial fibrillation. Despite increasing use, expansive dosing criteria and strict monitoring guidelines, inappropriate doses of DOACs are being prescribed in the community. Recent studies predicted that 15%-20% of elderly patients with AF were receiving inappropriate DOAC doses, with most underdosed. Patients are thus at risk of increased bleeding if overdosed or thrombotic events if underdosed. Method 85 patients

Introduction: Frailty is common in older patients with acute hip fractures. It has also been shown to be associated with poorer outcomes such as increased risk of infections, length of stay and increased 30-day mortality. Preoperative anaemia is also common in this cohort and is associated with adverse outcomes. Aims: To assess the relationship between frailty and preoperative haemoglobin and to explore the effect of gender. Methods: A retrospective study of hospitalized acute hip fractures patients. Anonymized data were extracted from the electronic notes of patients admitted from January to

Introduction Effective communication with patients and families is central to safe, person-centred care, particularly in geriatrics where fluctuating capacity, ReSPECT/ceiling-of-care decisions, uncertainty and family involvement are common. Local feedback identified that clinicians often face difficult conversations under significant ward pressure, with barriers including limited time, uncertainty about plans, medico-legal anxiety and emotionally charged interactions. This QIP aimed to develop a practical, sustainable communication toolkit to support clinicians before, during and after

Introduction: Population ageing is increasing pressure on acute hospital services, with the proportion aged ≥65 years projected to rise from 10% to 16% by 2050. Whether frailty-triggered comprehensive geriatric assessment (CGA) improves outcomes and quality of life compared with usual front-door care is therefore increasingly important. Methods: PubMed, Embase and CINAHL were searched from inception to July 2026 for comparative studies of older adults attending acute hospital front-door services. Studies were included where frailty or geriatric-risk identification directly triggered CGA

Introduction Patients attending falls clinics frequently have polypharmacy. During acute illness, some commonly prescribed medications may need to be temporarily withheld to reduce the risk of complications. Guidance on this is commonly known as medication “sick day rules”. Medications review is an inherent part of Comprehensive Geriatric Assessment but patient education on sick day rules is not routinely included. This project assessed whether improved awareness of sick days rules was needed in this population and whether a patient information leaflet could be a feasible educational tool

Aim: To examine how patients with MLTC, informal carers, and community healthcare professionals (HCPs) understand and explain each other’s roles in MLTC management in areas of socioeconomic deprivation. Design: Qualitative interview study using a critical contextualist framework. Participants were recruited through general practices across multiple sites in England serving populations experiencing socioeconomic deprivation. Methods: Semi-structured interviews with 58 participants: 28 patients with MLTC, 12 informal carers, and 18 community HCPs, analysed using thematic synthesis informed by a

Background: Timely completion of Treatment Escalation Plans (TEPs) support appropriate clinical decision-making, ensure patients' wishes are respected, and help avoid inappropriate interventions. Delays in escalation planning may lead to unnecessary treatments or resuscitation attempts, particularly in older adults with frailty and multimorbidity who are at high risk of deterioration. This quality improvement project aimed to increase timely TEP completion, targeting 90% of patients having a documented TEP within 72 hours of admission. Methods: Between February and July 2026, three Plan-Do