Posters

Urgent Community Assessment: A realist review of what works, for whom, and in what circumstances for older adults after a fall. P Garraway1; L Woods1; B Raut1; R Dewar-Haggart2; S Lunuwila1; S McKelvie1 1University of Southampton 2University of Oxford Introduction: Falls have a considerable effect on the physical and mental health of older adults. Urgent Community Response (UCR) services are increasing offered as a Community Alternative to aCute Hospitalisation (CAtCH) for falls management. These services often provide a home based assessments following an fall but there is limited

Over a 6 month period, all 92 residents were offered the opportunity to have a ReSPECT conversation and 86 accepted the opportunity. In addition to families/legal representatives, advocacy services were used to enable equitable participation. Digitally-facilitated communication tools were also offered. The vast majority responded positively, and a mutually agreed ReSPECT form was completed. These were stored electronically on NHS systems and shared with the care home in paper format. However, even when offered all available information some residents chose not to have a ReSPECT placing

A Treatment Escalation Plan is a document that records and communicates a patient’s treatment goals and preferences, should their general health or condition worsen. A TEP can include but is not limited to: resus status, preferred place of care or death, if imaging/IVs/venepuncture is appropriate. Treatment Escalation Plans aim to minimise harm from over or under treatment; provide clear continuity of care between healthcare professionals; and prevent futile or burdensome interventions which may be contrary to patient wishes. TEPs can be recorded on the computer system, TRAK. The aim was to

Introduction We were wanting to better understand the population of older people accessing a district hospital emergency department, to identify how a front door frailty team could be utilized and estimate the potential impact this could have for the hospital. Method All patients over the age of 65 who were within the Emergency department on 4 consecutive Thursdays between 8am and 4pm were assessed and proposed a potential intervention from a front door frailty team (either to be streamed to an SDEC or community service, receive a review in ED, ward follow up, or no intervention at all). All

Introduction Frailty in older adults increases risk of hospital admission, prolonged stay, and poorer outcomes. The NHS Long-Term Plan emphasises early identification, admission avoidance, and shifting care into the community to reduce system pressures and improve patient outcomes. Bromley has one of the largest and fastest-growing older populations in South East London. The One Bromley Hospital at Home (H@H) service is a multidisciplinary, person-centred service, integrating step-up and step-down pathways. Dedicated frailty and palliative care arms ensure high-risk patients receive

Introduction Frail older patients with hearing impairments face significant communication challenges in acute care settings such as the Emergency Department (ED) and Same Day Emergency Care (SDEC). These challenges often lead to misdiagnoses, increased anxiety, and diminished patient satisfaction. Improving communication for such patients is critical to enhancing their care experience, maintaining dignity, and improving overall satisfaction and outcomes. Method A Quality Improvement Project (QIP) was conducted involving ten participants over 75 years who were identified with hearing

Introduction: In operative patients, frailty results in increased rates of postoperative morbidity and mortality. The BGS guidelines for perioperative care stipulate that all patients over the age of 65 should have a clinical frailty score (CFS) documented within 72 hours of admission. One benefit of recognising frailty and increased risk of death is timely establishment of a ceiling of care (CoC) for patients undergoing emergency surgery, in line with the NICE guidelines for advanced care planning. In our orthogeriatric department preliminary data suggested that the CFS was almost never

Introduction: Treatment Escalation Planning (TEP) ensures timely clinical decision-making and appropriate responses to patient deterioration. This project aims to assess compliance with TEP documentation in the acute respiratory ward, identify gaps, and implement strategies for effective documentation. Methods: 3 PDSA cycles were completed using a quality improvement strategy, each for 5 days. Data was collected retrospectively using the patient’s electronic records, assessing key metrics such as TEP presence in patient’s notes and TEP TAB, DNACPR documentation, and time from admission to TEP

Introduction: Osteoporosis causes significant deterioration of bone health predisposing individuals to an increased risk of fractures. Hip fractures in particular lead to increased mortality, morbidity and substantial economic burden on the healthcare system. Early identification of high-risk individuals is crucial to improve patient-related outcomes and significantly reduce the burden on our healthcare system. The objective of this quality improvement project (QIP) is to promote osteoporosis risk assessment in the frailty unit at North Manchester General Hospital (NMGH), by introducing a

The acute care system is operating at maximal capacity, A&E is in an ‘awful state’, and there is continual rising of demand [1]. The ageing population is a triumph and challenge, with more living with frailty and complex needs [2]. Demand continues to escalate, and our services need to respond to this new reality [3]. Barnet Hospital is situated within the largest population of older people and with the greatest number of care homes in London. Our local ageing population provides opportunities to develop SDEC services for frail patients traditionally underserved and excluded [4]. For patients

Introduction The Commissioning for Quality and Innovation (CQUIN) framework sets a 10% minimum and an ideal goal of 30% of acutely presenting patients over the age of 65 to receive frailty assessment scores. Early recognition of frailty helps mitigate risks such as deconditioning. This project aims to assess and improve the adoption of this standard in medical emergency admissions of a Birmingham district general hospital by working with medical admissions teams and frailty services and observing for associated outcome measures. Methodology PDSA methodology was used. Data was retrospectively

Title: Unseen Spine: A Case of Infective Discitis masked by diverticulitis in older patient Introduction: Spinal infections include vertebral osteomyelitis, septic discitis, facet joint septic arthritis, and spinal epidural abscesses. The common presentation usually involves back pain, fever, and elevated inflammatory markers, with signs of neurological deficits implying presence of spinal epidural abscess. Spinal infections are infrequent (0.2–3.7 per 100,000 hospital admissions for spondylodiscitis), with relatively higher incidence in older patients. Case presentation: We present a case of

The Frailty Hotline is a follow-up service designed to provide ongoing care and support to patients discharged from the frailty service. Patients who have previously been under the care of the frailty team are given a dedicated phone number that allows them to escalate non-urgent concerns regarding their health. This service ensures that patients continue to receive appropriate care and guidance while remaining in their home environment, reducing the need for unnecessary hospital visits. This quality improvement project sought to evaluate the effectiveness of the Frailty Hotline in reducing

Introduction Frailty is associated with delayed clinical assessment in ED, increased length of stay (LOS) and inpatient mortality. Frail older adults have complex medical and psychosocial problems, difficult to address in ED. In line with the NHS Long Term Plan, our fSDEC pilot aimed: to deliver early comprehensive geriatric assessments (CGA); manage acute presentations to avoid unnecessary admissions; reduce ED waits and reduce the LOS for those admitted. Methods The fSDEC pilot had an ACP, a trainee ACP and two resident doctors (SHO and registrar) with support from a consultant and access to

Implementation of Advanced Clinical Practitioners as part of developing a ‘front door’ frailty service at Weston General Hospital. Weston General Hospital (WGH) site, within University Hospitals Bristol and Weston is developing its front door frailty services with the aim of becoming a centre of excellence for frailty. With up to 55% of admissions resulting in deconditioning (1) and geriatric medicine being the largest specialty in general medicine, there is a clear need for an advanced practitioners. 21.4% of Weston-Super-Mare’s population is aged >65 (2); suboptimal management of this

Introduction There is a drive for same day emergency care (SDEC) assessments of older frail patients attending hospitals. Multiple documents suggest how frailty SDEC services could work. Methods A trial of a mobile frailty SDEC, the Frailty Intervention Team (FIT) took place for 4 weeks in October 2020.. Data were collected manually but most of the presented data was indirect, such as length of stay of all older frail patients, rather than directly related to who FIT had seen. As FIT developed it was clear that data collection required automation. This was achieved through use of specific

Introduction Delirium is a common presentation in frail, older, hospitalized patients (approximately 25% of admissions, with 50%+ on surgical wards), with a high mortality (approximately 22% during the hospital stay) with more associated, avoidable deaths than sepsis. Delirium is underdiagnosed. The National Institute for Health and Care Excellence (NICE) recommend using a validated screening tool on all patients at risk or showing evidence of delirium. “Getting it Right First Time, Geriatric Medicine” recommends all patients aged 75 or more, should be assessed using the 4AT tool (a validated

Introduction “Getting it Right First Time – Geriatric Medicine” recommends the Clinical Frailty Scale (CFS) should be completed in patients aged 75+ on arrival in the Emergency Department (ED). Frailty services should focus on patients with a score of 5 or 6. The CFS has been shown to be easily completed in ED, however completion was variable. Methods A Frailty Intervention Team (FIT) based in ED was developed at the Royal Lancaster Infirmary. Around the same time the CFS was embedded into the trust’s electronic Manchester Triage Tool (MTT-CFS) within the Electronic Patient Record, along with

Introduction: With an aging population, the number of patients living with frailty will rise. Thus, there is a growing recognition by educators that medical students must be adequately prepared to meet the needs of this population group. To achieve this, one Scottish medical school is carrying out curriculum redesign, including exploring how to add frailty to the curriculum. Informing this process, and education on frailty more widely, this research aimed to explore how educators within this Scottish Medical School perceived frailty and determine how teaching on frailty should be approached

Introduction The UK population is ageing quickly, with the number of individuals over 65 rising from 9.2 million to 11 million in the last decade. This increase has led to more comorbidities and complex treatment regimens, often referred to as polypharmacy, which can cause adverse effects, increase admissions, mortality and high healthcare costs. To address these issues, the NHS is adopting a patient-centred approach to optimise medication use and improve outcomes. This includes evaluating patients, setting shared goals, and identifying unnecessary or harmful medications. Data was gathered