9 Patient Outcomes From A General Inpatient Rehabilitation Ward, Does Frailty or Reason for Admission Make A Difference to Patient Outcome?

Abstract Introduction With our ageing population there is increasing number of patients who experience a decline in their mobility either because of their underlying diagnosis or as a consequence of their hospital stay. There are only a limited number of inpatient rehabilitation beds and it is therefore important to identify those that would benefit the most from inpatient rehabilitation. Method We undertook a retrospective study looking at three months of discharges from an inpatient rehabilitation ward in Manchester. Patients were categorised based on diagnosis (Pubic rami fracture, other fractures, fall with no bony injury and finally medical reasons) and Clinical Frailty Score to see if either had any effect on whether patients mobility improved and to what degree. Results Patients with a reduced mobility on admission were identified and then categorised based on diagnosis. Of those patients admitted with a pubic rami fracture 66.7% improved on the ward with 33.3% of patients reaching their baseline mobility. The mobility of 85.7% of patients with other fractures improved with 42.9% reaching their baseline. Patients admitted following a fall without bony injury showed, 75% improvement with 50% reaching their baseline. Of those admitted for medical reasons 88.9% of those improved but only 22.2% reaching their baseline mobility. The lowest proportion of any category. Those admitted for medical reasons also had the longest median average stay on the rehab ward (33.5 days) followed by other fractures (33 days) then fall with no bony injury (21.5 days) and finally the shortest average stay, pubic rami fractures (20 days). Patients were also grouped occurring to their preadmission Clinical Frailty Score. With the exception of those who scored four (only a small number of patients), there was a negative correlation between an increasing frailty score and the proportion of patients whose mobility improved. However as frailty score increased the proportion of patients who improved to their baseline increased. Conclusion Our study has shown that the majority of patients benefitted from their admission regardless of diagnosis, however those admitted for medical reasons had the lowest chance of reaching their baseline mobility despite the longest admissions on the ward. Further research may be beneficial to investigate if they do better in a different rehabilitation setting.

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Imaging of Bacteria: Is there Any Hope for the Future Based on Past Experience?

Current Pharmaceutical Design ◽

10.2174/1381612823666171122111558 ◽

2018 ◽

Vol 24 (7) ◽

pp. 772-786 ◽

Cited By ~ 4

Author(s):

Thomas Ebenhan ◽

Elena Lazzeri ◽

Olivier Gheysens

Keyword(s):

Clinical Practice ◽

Sterile Inflammation ◽

Ageing Population ◽

Major Health Problem ◽

Major Health ◽

Number Of Patients ◽

Implanted Medical Devices ◽

Neutropenic Patients ◽

Socio Economic Impact ◽

Made In

Infectious diseases remain a major health problem and cause of death worldwide. It is expected that the socio-economic impact will further intensify due to escalating resistance to antibiotics, an ageing population and an increase in the number of patients under immunosuppressive therapy and implanted medical devices. Even though radiolabeled probes and leukocytes are routinely used in clinical practice, it might still be difficult to distinguish sterile inflammation from inflammation caused by bacteria. Moreover, the majority of these probes are based on the attraction of leukocytes which may be hampered in neutropenic patients. Novel approaches that can be implemented in clinical practice and allow for swift diagnosis of infection by targeting the microorganism directly, are posing an attractive strategy. Here we review the current strategies to directly image bacteria using radionuclides and we provide an overview of the preclinical efforts to develop and validate new approaches. Indeed, significant progress has been made in the past years, but very few radiopharmaceuticals (that were promising in preclinical studies) have made it into clinical practice. We will discuss the challenges that remain to select good candidates for imaging agents targeting bacteria.

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67 The Evolution of A Frailty Service

Age and Ageing ◽

10.1093/ageing/afab030.28 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

C Abbott ◽

K Bishop ◽

F Hill ◽

C Finlow ◽

R Maraj

Keyword(s):

Cost Effectiveness ◽

Patient Outcomes ◽

Local Population ◽

Management Team ◽

Pdsa Cycle ◽

North Wales ◽

Number Of Patients ◽

Constant State ◽

Clinical Resource ◽

Improve Patient

Abstract Introduction In September 2017 our frailty service was started within our medium sized DGH in North Wales. Working with our management team we secured a significant clinical resource including: We describe how resources, setting and staffing develop over a 2 year period in order to create a service which meets the needs of the local population. Method The service has been in a constant state of development since it has been in operation, utilising a PDSA model with regular meetings of clinical and managerial staff to analyse performance. Results With each new PDSA cycle the amount of patients reviewed has increased. With the move to AMU we increased the monthly number of patients reviewed from 29 to 172 patients reviewed, 97 of which were discharged directly from the unit. Conclusion Using QI methodology our Frailty Service has improved dramatically since its inception. We will continue to analyse how we work to improve patient outcomes and cost effectiveness.

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ADL Outcome of Stroke by Stroke Type and Time from Onset to Admission to a Comprehensive Inpatient Rehabilitation Ward

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2021.106110 ◽

2021 ◽

Vol 30 (12) ◽

pp. 106110

Author(s):

Masanori Matsubara ◽

Shigeru Sonoda ◽

Makoto Watanabe ◽

Yuko Okuyama ◽

Hideto Okazaki ◽

...

Keyword(s):

Inpatient Rehabilitation ◽

Rehabilitation Ward ◽

Stroke Type

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Factors determining eligibility and access to subacute rehabilitation for elderly people with dementia and hip fracture

Dementia ◽

10.1177/1471301215599704 ◽

2015 ◽

Vol 16 (4) ◽

pp. 413-423 ◽

Cited By ~ 9

Author(s):

Rosemary A McFarlane ◽

Stephen T Isbel ◽

Maggie I Jamieson

Keyword(s):

Hip Fracture ◽

Best Practice ◽

Inpatient Rehabilitation ◽

Models Of Care ◽

Cochrane Library ◽

Ageing Population ◽

Barriers To Access ◽

People With Dementia ◽

Vulnerable Patients ◽

The Cochrane Library

With hip fracture and dementia increasing in incidence in the global ageing population, there is a need for the development of specific procedures targeting optimal treatment outcomes for these patients. This paper looks primarily at the factors that limit access to subacute rehabilitation services as a growing body of evidence suggests that access to timely inpatient rehabilitation increases functional outcomes for patients both with dementia and without. Information was gathered by searching electronic data bases (SCOPUS, Medline, CINAHL, Health Source Nursing/Academic Addition, Psychinfo and the Cochrane Library) for relevant articles using the search terms dementia OR Alzheimer* AND hip fracture AND subacute rehabilitation OR convalescence for the period 2005–2015. Abstracts were scanned to identify articles discussing eligibility and access. A total of nine papers were identified that directly addressed this topic. Other papers discussing success or failure of rehabilitation and improved models of care were also reviewed. Barriers to access discussed in the literature include information management, management of comorbidities, attitudes, resource availability, and the quality of evidence and education. By identifying these factors we can identify strategic points of intervention across the trajectory of prevention, treatment and rehabilitation that may improve outcomes for this growing group of vulnerable patients. Emerging best practice for these patients is also discussed.

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Clinical engagement: a new concept or common sense all round?

Australian Health Review ◽

10.1071/ah18010 ◽

2019 ◽

Vol 43 (4) ◽

pp. 392

Author(s):

Stephen Bolsin ◽

Jenny Carter ◽

Aileen Kitson ◽

Donna Walter ◽

Stephen Roberts

Keyword(s):

Patient Outcomes ◽

Common Sense ◽

Employee Satisfaction ◽

Clinical Governance ◽

Healthcare Organisation ◽

Number Of Patients ◽

Clinical Engagement ◽

To Receive ◽

Professional Disciplines

Clinical engagement has supplemented clinical governance in healthcare to strengthen the contribution of medical professionals to the assessment of clinical outcomes for patients. Assessments of clinical engagement have, until now, been qualitative; this case study introduces the concept of quantitative assessment of clinical engagement by measuring the number of patients managed according to specialist society guidelines. Such an assessment engages all staff (medical, nursing, allied health and pharmacy) involved in patients receiving treatment according to such guidelines and provides an assessment of individual and organisational compliance with those guidelines. Clinical engagement is then quantified as the percentage of patients that have been documented to receive specialist society- or college-approved guideline-compliant treatment, relative to the total number who could receive such treatment, in any healthcare organisation. What is known about the topic? Clinical engagement has emerged in recent years as a virtue to be encouraged in healthcare organisations because of its association with improved patient outcomes and employee satisfaction. Assessments have relied on repeated staff surveys in order to gauge engagement. What does this paper add? This paper proposes a novel means of measuring clinical engagement in an organisational setting. The vision put forward is that adherence to clinical guidelines in an organisation measures clinician engagement across professional disciplines. What are the implications for practitioners? The implications are that organisations will contribute to measuring the adherence of specialty groups of clinicians to guidelines that the clinicians select and use the data for individual and organisational accreditation.

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The Impact of Level of Physical Therapist Assistant Involvement on Patient Outcomes Following Stroke

Physical Therapy ◽

10.1093/ptj/pzaa158 ◽

2020 ◽

Vol 100 (12) ◽

pp. 2165-2173

Author(s):

Jennifer Biggs

Keyword(s):

Length Of Stay ◽

Functional Outcome ◽

Patient Outcomes ◽

Physical Therapist ◽

Inpatient Rehabilitation ◽

Scoring Methods ◽

Regression Analyses ◽

Rehabilitation Facility ◽

Physical Therapist Assistant ◽

Discharge Location

Abstract Objective This study investigates if higher utilization of physical therapist assistants adversely affects patient outcomes in the acute rehabilitation setting for patients following a cerebrovascular accident (CVA). Methods Participants were admitted to 1 of 5 inpatient rehabilitation facilities following a CVA from 2008 to 2010. High physical therapist assistant use was defined as ≥20% of the physical therapist visits being provided by the physical therapist assistant for an episode of care. Multivariable regression techniques examined differences in functional outcome, discharge location, and length of stay between high and low physical therapist assistant use groups. Propensity scoring methods supplemented findings of the regression analyses. Results Of the 1561 participants, 496 (32%) had high physical therapist assistant involvement. Baseline participant characteristics such as age, sex, baseline motor function, and comorbidities did not differ between high and low physical therapist assistant use groups. After adjusting for patient characteristics, rehabilitation facility, and year, higher physical therapist assistant use did not adversely affect functional outcome or length of stay. Fewer conclusions can be drawn regarding discharge location, although there was no significant difference in discharge location between groups with high and low physical therapist assistant utilization. Propensity scoring methods supported the findings of the regression analyses. Conclusions Higher physical therapist assistant involvement in the rehabilitation of patients following CVA did not adversely affect functional outcome, increase length of stay, or reduce the likelihood of discharge to home from an inpatient rehabilitation facility. Impact The results demonstrate the value of the physical therapist assistant in the provision of physical therapy for patients with stroke in the inpatient rehabilitation setting. Higher involvement of the physical therapist assistant may provide cost savings while maintaining patient outcomes for this setting and population.

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99 Safer Mobility: Practice vs Preach

Age and Ageing ◽

10.1093/ageing/afz103.59 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Sive Carey ◽

Adefunke Salawu ◽

Marian Glynn

Keyword(s):

Physical Activity ◽

Inpatient Rehabilitation ◽

Geriatric Rehabilitation ◽

Activity Levels ◽

Ward Staff ◽

Rehabilitation Team ◽

Staff Members ◽

Ward Level ◽

Rehabilitation Ward ◽

Mobility Status

Abstract Background Activity levels in older people undergoing inpatient rehabilitation are low. Intervention by the rehabilitation team amounts to 2% of a patient’s day. Interdisciplinary working helps to ensure that therapy continues beyond the physiotherapy gym. However, safe handling is required. Aims Examine the awareness of ward staff of the mobility status of their patients. Investigate if staff on a general geriatric rehabilitation ward are compliant with physiotherapy mobility recommendations. Methods Data collection took place on a general geriatric rehabilitation ward from February to March 2019. Staff Awareness was assessed by individually asking ward staff (Nurses and Health Care Assistants) to identify the mobility status of their patients. Their responses were recorded and compared with the physiotherapy mobility recommendations as per the MDT (multi-disciplinary) communication whiteboard. The mobility status of each patient was observed by means of random visual audits. Observations were recorded and subsequently compared to the physiotherapy mobility recommendations as above for compliance. Results For the staff awareness audit, 95 responses were obtained from 10 different staff members. 50.5% of responses (n=48) correctly identified patients’ mobility status. 49.5% (n=47) incorrectly identified patients’ mobility status. From 10 visual audits, a total of 196 patient observations were recorded. In 37.2% (n=73) of observations, patients were not mobilising as per physiotherapy recommendations. 39.3% (n=77) of observations were as recommended. In 23.5% (n=46) of observations, patients were not mobilised at all. Conclusion There was limited awareness among ward staff of the mobility status of their patients. Over 1/3 of patients were not mobilised as per physiotherapy recommendations. These findings can compromise both patient and staff safety. The visual audit also highlighted low physical activity levels in some patients. Implications for clinical practice include the need for education on safer mobility and the promotion of patient physical activity at ward level. Physiotherapy led educational and practical handling sessions for ward staff have proven to be beneficial in this regard.

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88 The Truth Behind the Pubic Rami Fracture: Identification of Pelvic Fragility Fractures at A University Teaching Hospital

Age and Ageing ◽

10.1093/ageing/afz193.03 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i28-i29

Author(s):

D van Berkel ◽

O Herschkovich ◽

R Taylor ◽

T Ong ◽

O Sahota

Keyword(s):

Older People ◽

Pelvic Fracture ◽

Plain Radiograph ◽

Fragility Fractures ◽

University Teaching ◽

Acetabular Fractures ◽

Sacral Fractures ◽

Pubic Rami ◽

Number Of Patients ◽

Pelvic Imaging

Abstract Introduction Older patients presenting with pelvic fragility fractures (PFF) is an increasing epidemic. The most common pelvic fracture identified by plain radiograph is pubic rami fracture. These fractures are painful and often require admission to hospital. However, despite optimal analgesia, many of these patients struggle to mobilise and may have fractures of the posterior pelvic ring, which are overlooked and not visible on plain radiograph imaging. We aimed to quantify the number of patients progressing to further pelvic imaging in the form of computed tomography (CT) or magnetic resonance imaging (MRI) and the presence of concurrent fractures. Methods Prospective screening of pelvic imaging in patients aged over 70 years was undertaken at Nottingham University Hospitals NHS Trust over an 8-month period from October 2018. Results 103 predominantly female (83%) patients were confirmed to have an acute fragility fracture of the pubic rami on plain radiograph. 19% of patients were discharged direct from the Emergency Department, 45% were admitted to Health Care of Older People (HCOP) teams, 30% to Trauma and Orthopaedic (T&O) teams and 6% to other specialities. 25% of the patients admitted underwent further pelvic imaging, which confirmed fragility fractures of the pubic rami in 88%, with 40% showing acetabular fractures and 68% showing sacral fractures of all types. A further 10 patients were diagnosed with pubic rami insufficiency fractures on further imaging, having had a normal initial radiograph, but had been admitted with poor mobility due to groin pain. In these 10 patients, 20% also had an acetabular fracture and 60% sacral fractures. Overall, 59% of patients with pubic rami fractures had an ipsilateral sacral fracture; a Type 1 Lateral Compression pelvic fracture by AO classification. Conclusions Pubic rami fractures are a significant problem in older people and often require admission to hospital. Further imaging confirms these fractures are complex, with co-existing fractures of the acetabulum and sacrum common. However despite this, only a quarter of patients admitted had further imaging. Where pelvic fractures are missed or severity not appreciated, appropriate pain control can be more difficult to achieve. With the potential for minimally invasive surgical options to aid pain management in sacral fractures, it may be prudent for all patients hospitalised with suspected or confirmed pelvic fracture to undergo further imaging.

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