scholarly journals Evidence-based intervention to reduce avoidable hospital admissions in care home residents (the Better Health in Residents in Care Homes (BHiRCH) study): protocol for a pilot cluster randomised trial

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e026510 ◽  
Author(s):  
Elizabeth L Sampson ◽  
Alexandra Feast ◽  
Alan Blighe ◽  
Katherine Froggatt ◽  
Rachael Hunter ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Hospital Admissions ◽  
Care Home ◽  
Care Homes ◽  
System Level ◽  
Link Type ◽  
Cluster Randomised ◽  
Level Data ◽  
Tract Infections ◽  
Practice Development

IntroductionAcute hospital admission is distressing for care home residents. Ambulatory care sensitive conditions, such as respiratory and urinary tract infections, are conditions that can cause unplanned hospital admission but may have been avoidable with timely detection and intervention in the community. The Better Health in Residents in Care Homes (BHiRCH) programme has feasibility tested and will pilot a multicomponent intervention to reduce these avoidable hospital admissions. The BHiRCH intervention comprises an early warning tool for noting changes in resident health, a care pathway (clinical guidance and decision support system) and a structured method for communicating with primary care, adapted for use in the care home. We use practice development champions to support implementation and embed changes in care.Methods and analysisCluster randomised pilot trial to test study procedures and indicate whether a further definitive trial is warranted. Fourteen care homes with nursing (nursing homes) will be randomly allocated to intervention (delivered at nursing home level) or control groups. Two nurses from each home become Practice Development Champions trained to implement the intervention, supported by a practice development support group. Data will be collected for 3 months preintervention, monthly during the 12-month intervention and 1 month after. Individual-level data includes resident, care partner and staff demographics, resident functional status, service use and quality of life (for health economic analysis) and the extent to which staff perceive the organisation supports person centred care. System-level data includes primary and secondary health services contacts (ie, general practitioner and hospital admissions). Process evaluation assesses intervention acceptability, feasibility, fidelity, ease of implementation in practice and study procedures (ie, consent and recruitment rates).Ethics and disseminationApproved by Research Ethics Committee and the UK Health Research Authority. Findings will be disseminated via academic and policy conferences, peer-reviewed publications and social media (eg, Twitter).Trial registration numberISRCTN74109734; Pre-results.

scholarly journals Reducing urinary tract infections in care homes by improving hydration

2019 ◽  
Vol 8 (3) ◽  
pp. e000563 ◽  
Author(s):  
Katie Lean ◽  
Rasanat Fatima Nawaz ◽  
Sundus Jawad ◽  
Charles Vincent
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Hospital Admissions ◽  
Low Cost ◽  
Care Home ◽  
Kidney Injury ◽  
Care Staff ◽  
Care Homes ◽  
Raising Awareness ◽  
Tract Infections

Dehydration may increase the risk of urinary tract infections (UTIs), which can lead to confusion, falls, acute kidney injury and hospital admission. We aimed to reduce the number of UTIs in care home residents which require admission to hospital. The principal intervention was the introduction of seven structured drink rounds every day accompanied by staff training and raising awareness. UTIs requiring antibiotics reduced by 58% and UTIs requiring hospital admissions reduced by 36%, when averaged across the four care homes. Care home residents benefited from greater fluid intake, which in turn may have reduced infection. Structured drink rounds were a low-cost intervention for preventing UTIs and implemented easily by care staff.

scholarly journals Pilot cluster randomised trial of an evidence-based intervention to reduce avoidable hospital admissions in nursing home residents (Better Health in Residents of Care Homes with Nursing—BHiRCH-NH Study)

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040732
Author(s):  
Elizabeth L Sampson ◽  
Alexandra Feast ◽  
Alan Blighe ◽  
Katherine Froggatt ◽  
Rachael Hunter ◽  
...  
Keyword(s):  
Nursing Home ◽  
Early Detection ◽  
Complex Intervention ◽  
Hospital Admissions ◽  
Randomised Trial ◽  
Family Carers ◽  
Link Type ◽  
Cluster Randomised ◽  
Practice Development ◽  
Full Trial

ObjectivesTo pilot a complex intervention to support healthcare and improve early detection and treatment for common health conditions experienced by nursing home (NH) residents.DesignPilot cluster randomised controlled trial.Setting14 NHs (7 intervention, 7 control) in London and West Yorkshire.ParticipantsNH residents, their family carers and staff.InterventionComplex intervention to support healthcare and improve early detection and treatment of urinary tract and respiratory infections, chronic heart failure and dehydration, comprising: (1) ‘Stop and Watch (S&W)’ early warning tool for changes in physical health, (2) condition-specific care pathway and (3) Situation, Background, Assessment and Recommendation tool to enhance communication with primary care. Implementation was supported by Practice Development Champions, a Practice Development Support Group and regular telephone coaching with external facilitators.Outcome measuresData on NH (quality ratings, size, ownership), residents, family carers and staff demographics during the month prior to intervention and subsequently, numbers of admissions, accident and emergency visits, and unscheduled general practitioner visits monthly for 6 months during intervention. We collected data on how the intervention was used, healthcare resource use and quality of life data for economic evaluation. We assessed recruitment and retention, and whether a full trial was warranted.ResultsWe recruited 14 NHs, 148 staff, 95 family carers and 245 residents. We retained the majority of participants recruited (95%). 15% of residents had an unplanned hospital admission for one of the four study conditions. We were able to collect sufficient questionnaire data (all over 96% complete). No NH implemented intervention tools as planned. Only 16 S&W forms and 8 care pathways were completed. There was no evidence of harm.ConclusionsRecruitment, retention and data collection processes were effective but the intervention not implemented. A full trial is not warranted.Trial registration numberISRCTN74109734 (https://doi.org/10.1186/ISRCTN74109734).Original protocolBMJ Open. 2019;9(5):e026510. doi:10.1136/bmjopen-2018-026510.

scholarly journals Care homes education: what can we learn?

2021 ◽  
Vol 10 (1) ◽  
pp. e001153
Author(s):  
Sarah Frances Armstrong ◽  
Tim Gluck ◽  
Anna Gorringe ◽  
Annie Stork ◽  
Sally Jowett ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Medical Care ◽  
Communication Systems ◽  
Hospital Admissions ◽  
Early Recognition ◽  
Care Home ◽  
Internal Communication ◽  
Care Homes ◽  
Attendance Rates ◽  
Teaching Programme

Medical care received by care home residents can be variable. Initiatives, such as matron-led community teams, ensure a timely response to alerts about unwell residents. But early recognition of deterioration is vital in accessing this help. The aim of this project was to design and deliver an education programme for carers. It was hypothesised that the implementation of a teaching programme may result in improved medical care for residents. By understanding the enablers and barriers to implementing teaching, we hoped to identify the components of a successful teaching programme. Four care homes in Enfield received training on topics such as deterioration recognition over a 1-year period. The project was evaluated at 3, 6 and 9 months. Each evaluation comprised: pre-and-post-teaching questionnaires, focus groups, analysis of percentages of staff trained, review of overall and potentially avoidable, hospital admission rates. A Plan–Do–Study–Act cycle structure was used. The programme was well-received by carers, who gave examples of application of learning. Modules about conditions frequently resulting in hospital admission, or concerning real cases, demonstrated the best pre-and-post lesson change scores. However, the reach of the programme was low, with attendance rates between 5% and 28%. Overall, the percentage of staff trained in deterioration recognition ranged from 35% (care home one) to 12% (care home three). Hospital admissions reduced from 37 hospital admissions to 20 over the duration of the project. Potentially avoidable admissions reduced from 16 to 5. Proving causality to the intervention was difficult. Factors facilitating delivery of training included a flexible approach, an activity-based curriculum, alignment of topics with real cases and embedding key messages in every tutorial. Barriers included: time pressures, shift work, low attendance rates, inequitable perception of the value of teaching and IT issues. Care home factors impacting on delivery included: stability of management and internal communication systems.please ensure space here

scholarly journals 1683. Hospital Admission Patterns in Adult Patients with Complicated Urinary Tract Infections (cUTIs): Identification of Potentially Avoidable Hospital Admissions Across United States (US) Hospitals

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S825-S826
Author(s):  
Thomas Lodise ◽  
Teena Chopra ◽  
Brian Nathanson ◽  
Katherine Sulham
Keyword(s):  
Hospital Admission ◽  
Hospital Admissions ◽  
Panel Member ◽  
Inclusion Criteria ◽  
Independent Contractor ◽  
Healthcare Database ◽  
Admission Rates ◽  
Comorbidity Index ◽  
Multi Center Study ◽  
Tract Infections

Abstract Background There is an increase in hospital admissions for cUTI in the US despite apparent reductions in the severity of admissions. However, there are scant data on cUTI hospital admission rates from the emergency department (ED) stratified by age, infection severity, and presence of comorbidities. This study described US hospitalization patterns among adults who present to the ED with a cUTI. We sought to quantify the proportion of admissions that were potentially avoidable based on presence of sepsis and associated symtpoms as well as Charlston Comorbidity Index (CCI) scores. Methods A retrospective multi-center study using data from the Premier Healthcare Database (2013-18) was performed. Inclusion criteria: (1) age ≥ 18 years, (2) primary cUTI ED/inpatient discharge diagnosis, (3) positive blood or urine culture between index ED service days -5 to +2. Transfers from acute care facilities were excluded. Based on ICD-9/10 diagnosis codes present on admission, incidence of hospital admissions were stratified by age (≥ 65 years vs. < 65 years), presence of sepsis (S), sepsis symptoms but no sepsis codes (SS) (e.g., fever, tachycardia, tachypnea, leukocytosis, etc.), and CCI. Results 187,789 patients met inclusion criteria. The mean (SD) age was 59.7 (21.9), 40.4% were male, 29.4% had sepsis, 16.7% had at least 1 SS symptom (but no S), and 53.9% had no evidence of S or SS. The median [IQR] CCI was 1 [0, 3]. 119,668 out of 187,789 (63.7%) were admitted to hospital. Among inpatients, median [IQR] length of stay (LOS) and total costs were 5 [3, 7] days and $7,956 [$4,834, $13,960] USD. Incidence of hospital admissions by age, presence of S/SS, and CCI score are shown in the Table. 18.9% of admissions (22,644/119,668) occurred in patients with no S/SS and a CCI ≤ 2. Their median [IQR] LOS and total costs were 3 [2, 5] days and $5,575 [$3,607, $9,133]. Incidence of Hospital Admission by Age, Charlson comorbidity index (CCI), Presence of Sepsis (S), and Presence of Sepsis Symptoms (SS) Conclusion Nearly 1 in 5 cUTI hospital admissions may be avoidable. Given the resources associated with the management of inpatients with cUTIs, these findings highlight the critical need for healthcare systems to develop well-defined criteria for hospital admission based on presence of comorbid conditions and infection severity. Preventing avoidable hospital admissions has the potential to save the healthcare system substantial costs. Disclosures Thomas Lodise, PharmD, PhD, Paratek Pharmaceuticals, Inc. (Consultant) Teena Chopra, MD, MPH, Spero Therapeutics (Consultant, Advisor or Review Panel member) Brian Nathanson, PhD, Spero Therapeutics (Independent Contractor) Katherine Sulham, MPH, Spero Therapeutics (Independent Contractor)

scholarly journals COVID-19 risk factors amongst 14,786 care home residents: An observational longitudinal analysis including daily community positive test rates of COVID-19, hospital stays, and vaccination status in Wales (UK) between 1st September 2020 and 1st May 2021.

2021 ◽  
Author(s):  
Joe Hollinghurst ◽  
Robyn Hollinghurst ◽  
Laura North ◽  
Amy Mizen ◽  
Ashley Akbari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Hospital Admissions ◽  
Care Home ◽  
Vaccination Status ◽  
Care Homes ◽  
Positive Test ◽  
Care Providers ◽  
Specialist Care ◽  
Individual Level

Objectives: Determine individual level risk factors for care home residents testing positive for SARS-CoV-2. Study Design: Longitudinal observational cohort study using individual-level linked data. Setting: Care home residents in Wales (United Kingdom) between 1st September 2020 and 1st May 2021. Participants: 14,786 older care home residents (aged 65+). Our dataset consisted of 2,613,341 individual-level daily observations within 697 care homes. Methods: We estimated odds ratios (ORs [95% confidence interval]) using multilevel logistic regression models. Our outcome of interest was a positive SARS-CoV-2 polymerase chain reaction (PCR) test. We included time dependent covariates for the estimated community positive test rate of COVID-19, hospital admissions, and vaccination status. Additional covariates were included for age, positive PCR tests prior to the study, sex, frailty (using the hospital frailty risk score), and specialist care home services. Results: The multivariable logistic regression model indicated an increase in age (OR 1.01 [1.00,1.01] per year of age), community positive test rate (OR 1.13 [1.12,1.13] per percent increase in positive test rate), hospital inpatients (OR 7.40 [6.54,8.36]), and residents in care homes with non-specialist dementia care (OR 1.42 [1.01,1.99]) had an increased odds of a positive test. Having a positive test prior to the observation period (OR 0.58 [0.49,0.68]) and either one or two doses of a vaccine (0.21 [0.17,0.25] and 0.05 [0.02,0.09] respectively) were associated with a decreased odds of a positive test. Conclusions: Our findings suggest care providers need to stay vigilant despite the vaccination rollout, and extra precautions should be taken when caring for the most vulnerable. Furthermore, minimising potential COVID-19 infection for care home residents admitted to hospital should be prioritised.

scholarly journals Malnutrition in the UK: where does it begin?

2010 ◽  
Vol 69 (4) ◽  
pp. 465-469 ◽  
Author(s):  
C. A. Russell ◽  
M. Elia
Keyword(s):  
High Risk ◽  
Hospital Admissions ◽  
Care Home ◽  
Healthcare Services ◽  
Care Homes ◽  
Sheltered Housing ◽  
Nutrition Screening ◽  
Good Opportunity ◽  
Outpatient Departments ◽  
The Uk

More than 3 million individuals are estimated to be at risk of malnutrition in the UK, of whom about 93% live in the community. BAPEN's Nutrition Screening Week surveys using criteria based on the ‘Malnutrition Universal Screening Tool’ (‘MUST’) revealed that 28% of individuals on admission to hospital and 30–40% of those admitted to care homes in the previous 6 months were malnourished (medium+high risk using ‘MUST’). About three quarters of hospital admissions and about a third of care home admissions came from their own homes with a malnutrition prevalence of 24% in each case. Outpatient studies using ‘MUST’ showed that 16–20% patients were malnourished and these were associated with more hospital admissions and longer length of stay. In sheltered housing, 10–14% of the tenants were found to be malnourished, with an overall estimated absolute prevalence of malnutrition which exceeded that in hospitals. In all cases, the majority of subjects were at high risk of malnutrition. These studies have helped establish the magnitude of the malnutrition problem in the UK and identified the need for integrated strategies between and within care settings. While hospitals provide a good opportunity to identify malnourished patients among more than 10 million patients admitted there annually and the five- to six-fold greater number attending outpatient departments, commissioners and providers of healthcare services should be aware that much of the malnutrition present in the UK originates in the community before admission to hospitals or care homes or attendance at outpatient clinics.

PP34  Collecting experience-based expertise when planning prehospital care research: a stakeholder event about evaluating paramedics working in care homes

2020 ◽  
Vol 37 (10) ◽  
pp. e16.2-e16
Author(s):  
Bridie Evans ◽  
Mark Kingston ◽  
Alison Porter ◽  
Leigh Keen ◽  
Lesley Griffiths ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Prehospital Care ◽  
Care Home ◽  
Healthcare Services ◽  
Family Satisfaction ◽  
Care Homes ◽  
Research Development ◽  
Multiple Perspectives ◽  
Care Research ◽  
Wide Range

BackgroundDue to medical advances, the population of care homes is becoming increasingly frail, often with co-morbidities. Recent innovations have seen paramedics take on non-emergency roles within or supporting care homes. This workforce innovation requires urgent evaluation, taking account of the multiple perspectives at stake. Research is more relevant, feasible and accountable if those who commission, deliver and use healthcare services are able to input their professional and personal insights.MethodWe conducted a stakeholder event as part of research development work for paramedics working in care homes (PERCH: Preliminary Exploration of paramedic Roles in Care Homes). We invited representatives from care homes, including Enabling Research in Care Homes (ENRICH) network members, ambulance services, primary and secondary care, patient/resident and public members, and the research community. To inform discussion, we presented examples of paramedics working in care homes. We then facilitated small-group discussions about how to evaluate such innovations and recorded views on sticky notes and flipcharts.Results23 people attended the event. Clarity of roles and communication processes were considered important to implement the pilot project. Attendees agreed that research outcome measures should include changes in avoidable hospital admissions, emergency department attendances and 999 calls plus staff, patient and family satisfaction. They identified some potential benefits to ambulance services and general practice, such as time saved for other patients, but believed these could be difficult to measure.DiscussionGaining the insights of a wide range of stakeholders prior to research being designed is an important, but under-utilised approach in research development. People who deliver and receive community-based care have insight derived from personal and professional experience which complements research expertise. Research in care home settings is challenging, and insights from stakeholders were significant in the development of a research proposal about the role of paramedics in care homes (PERCH study). We submitted this to the Health and Care Research Wales Research for Public and Patient Benefit funding scheme in 2019.

35 Enhanced Service Through An Integrated New Model of Care in A Buckinghamshire Care Home

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i9-i10
Author(s):  
U Okoli ◽  
S Chimhau ◽  
B Nagyova ◽  
A Sahni ◽  
S Amin ◽  
...  
Keyword(s):  
Best Practice ◽  
Adverse Drug Events ◽  
Hospital Admissions ◽  
Care Home ◽  
Cost Savings ◽  
Care Homes ◽  
Multiple Chronic Conditions ◽  
Model Of Care ◽  
Nice Guideline ◽  
Care Plans

Abstract Introduction Care home residents often have multiple, chronic conditions and are receiving complex treatment regimes. Polypharmacy and medication errors are common. The frequency and quality of medication reviews is variable with limited general practice (GP) capacity to carry out comprehensive reviews. The initiative used a care home pharmacist, technician, geriatrician and GPs to tackle these issues on an individual and care home level. The objective being to ensure the safe and effective use of medicines for all care home residents. NICE guideline [NG56] recommends reducing pharmacological treatment burden for adults with multimorbidity at risk of adverse drug events such as unplanned hospital admissions. A study by Dilles et al1 found adverse drug reactions in 60% of residents. Methods A new interdisciplinary model of care was delivered in a 120 bedded Buckinghamshire care home. Clinical Commissioning Group pharmacist, general practitioners and pharmacy technician reviewed medication for all residents. The most complex individuals were reviewed by the geriatrician and if needed by other multidisciplinary team members specialist. Results Overall 115 medications were stopped for 109 residents, with 31 interventions to reduce falls risk and 19 interventions on medication at high risk2 of causing admission. Total cost savings on medicines optimisation, medicines waste and non-elective admission prevented was £35,211. Residents’ care plans were updated to reflect best practice standards. Conclusions Future direction of this project focuses on system wide improvements to promote interdisciplinary healthcare professionals work in care homes. The success of this integrated model of care has enabled recurrent funding of pharmacist by the local county council and an additional 42 geriatrician sessions into Buckinghamshire care homes. References 1. Dilles T, Vander Stichele R, Van Bortel L, Elseviers M. Journal of American Medical Directors Association 2013; 14: 371–6. 2. Pirmohamed M, et al. Br Med J 2004; 329: 15–9 61.

scholarly journals 39 Care Home Liaison Role- Bridging the Gap Between Acute Hospitals and Care Homes

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i11-i13
Author(s):  
C Sendall ◽  
P Wright ◽  
R Downes
Keyword(s):  
Hospital Admissions ◽  
Positive Impact ◽  
Care Home ◽  
Care Homes ◽  
Care Plan ◽  
Patient Pathways ◽  
Number Of Patients ◽  
Significant Difference ◽  
Acute Hospitals ◽  
Liaison Nurse

Abstract Introduction There are over 400,000 people over 65 in UK care homes, three times the number than that in acute hospitals. They are amongst the frailest in our community, with average life expectancy of 15months once in the home. Their needs are often complex and challenging, which when unmet, often result in unwanted and unnecessary hospital admissions. Imperial College Healthcare Trust (ICHT), along with funding from Health Education England (HEE), have introduced a care home liaison nurse. The aim is to bridge the boundaries, making a significant difference to cross organisation communication and support. Methods The care home liaison nurse manages a frailty liaison service with the largest local nursing care home. This home has 140 residents with complex needs. The care home liaison nurse provides a point of contact for advice, guidance and support for individual patient pathways, she provides face to face assessment and treatment or verbal advice. In addition, the nurse supports discharge from the acute setting. This direct contact allows rapid access to specialist advice, and aims to build confidence both within the care home team and within the acute team, that the patients’ needs can be met in their own surroundings. Results The preliminary data demonstrates a positive impact this role is having both to the acute trust and most importantly patient’s experience. Comparing ICHT data from April-May 2018 to April-May 2019 it showing that the number of avoidable admissions has decreased from 54.3% to 37.5%, length of stay when patients are admitted has decreased from 11.7 days to 6.5 days, and the number of patients with an advanced care plan has risen 14.9%. Feedback from nursing staff at the care centre as well as that from patients and families has been overwhelmingly positive. Conclusions The role is still in the pilot phase. Given the already positive impact it is hoped that it will continue and expand into other care homes and extra sheltered accommodations.

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