Prevalence and Associated Factors of Coexistence of Malnutrition and Sarcopenia in Geriatric Rehabilitation

Malnutrition and sarcopenia often coexist in rehabilitation patients, although they are often overlooked and undertreated in clinical practice. This cross-sectional study aimed to clarify the prevalence of the coexistence of malnutrition and sarcopenia (Co-MS) and its associated factors in convalescent rehabilitation wards in Japan. Consecutive patients aged ≥ 65 years in convalescent rehabilitation wards between November 2018 and October 2020 were included. Malnutrition and sarcopenia were determined by the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Asian Working Group for Sarcopenia (AWGS 2019) criteria, respectively. Patients who presented both with malnutrition and sarcopenia were classified as Co-MS. Potentially associated factors included age, sex, days from onset to admission of rehabilitation wards, reason for admission, pre-morbid functional dependency, comorbidity, activities of daily living, swallowing ability, and oral function and hygiene. The prevalence of malnutrition, sarcopenia, and Co-MS was calculated. Binary logistic regression analyses were performed to compute odds ratios (ORs) and the 95% confidence interval (CI) of possible associated factors for each condition. Overall, 601 patients were eligible for the analysis (median 80 years old, 355 female patients, 70% cerebrovascular disease). Co-MS, malnutrition, and sarcopenia were found in 23.5%, 29.0%, and 62.4% of the enrolled patients, respectively. After adjustment, onset–admission interval (OR = 1.04; 95%CI = 1.02 to 1.06), hospital-associated deconditioning (OR = 4.62; 95%CI = 1.13 to 18.8), and swallowing ability (Food Intake LEVEL Scale) (OR = 0.83; 95%CI = 0.73 to 0.93) were identified as independent explanatory factors of Co-MS. In conclusion, Co-MS was prevalent in geriatric rehabilitation patients; thus, healthcare professionals should be aware of the associated factors to detect the geriatric rehabilitation patients who are at risk of both malnutrition and sarcopenia, and to provide appropriate treatments.

Describing agreement in the Main Condition coding field using Canadian ICD-11 inpatient data

IntroductionCountries use varying coding standards, which impact international coded data comparability. The `main condition' (MC) field is coded within the Discharge Abstract Database as "reason for admission" or "largest resource use". ObjectiveWe offer a preliminary analysis on the frequency of and contributing factors to MC definition agreements within an inpatient Canadian dataset. MethodsSix professional coders performed a chart review between August 2016 and June 2017 on 3,000 randomly selected inpatient charts from three acute care hospitals in Calgary, Alberta. Coders classified the MC as "reason for admission", "largest resource use" or "both". Patients were admitted between 1st January and 30th June 2015 and met the inclusion criteria if they were >18 years, had an Alberta personal health care number, and had an inpatient visit for any service outside of obstetrics. Agreement between the two MC definitions was stratified by length of stay (LOS), emergency department admission, hospital of origin, discharge location, age, sex, procedures, and comorbidities. Chi-square analysis and frequency of inconsistencies were reported. ResultsOnly 34 (1.51%) of the 2,250 patient charts had disagreeing MC definitions. Age, emergency visit on admit, LOS, hospital, and discharge location were associated with MC agreement. Chronic conditions were seen more often in MC definition agreements, and acute conditions seen within those disagreeing. ConclusionThere was a small proportion of cases in which the condition bringing the patient to hospital was not also the condition occupying the largest resources. Within disagreements, further research using a larger sample size is needed to explore the presence of MC in a secondary/tertiary condition, the association between patient complexity and disagreeing MC definitions, and the nature of the conditions seen in the inconsistent MC definitions.

EP.TH.386Management of acute gallstone-related complications at Great Western Hospital

Aim Gallstone-related disease accounts for a third of the admissions to the Surgical Department. In June 2019, an audit was undertaken at Great Western Hospital assessing the number of patients who underwent cholecystectomy, following initial diagnosis, in accordance to current guidelines. The results demonstrated a very low number of patients had cholecystectomy, within the targeted timeframe, which led to the implementation of a dedicated operative “hot gallbladder” list weekly. In June 2020, we re-audit the service to evaluate the impact of the change implemented. Methods A retrospective observational analysis of patients admitted to the Hospital in June 2020 with gallstone-related disease. Data was collected using the Surgical on-call lists, these were analysed and patients selected according to the reason for admission. Only gallstone related issues were considered in this analysis. Finally, via Medway, the time from admission to surgery was assessed. Results Despite the disruption in service provision due to COVID-19, the implementation of the “hot gallbladder” list led to a 10.7% increase in timely cholecystectomies, bringing the overall compliance to 14%. There was also a significant reduction in biliary related re-admissions, from 58% to 37%. Despite 47.3% of patients were still awaiting surgery, the waiting list was reduced by 5.2% in only 1 year. Conclusions This study demonstrated that the implementation of the “hot gallbladder” list has improved the compliance with the current guidelines. The change has brought us in line with the national average of 15%, as estimated by RCSEng, therefore demonstrating the efficacy of the weekly list.

Asthma in Paediatric Intensive Care in England Residents: Observational Study

Purpose Despite high prevalence of asthma in children in the UK, there are no prior report on asthma admissions in paediatric intensive care units (PICU). Methods PICANet, a UK national PICU database, was queried for asthma as the primary reason for admission, of children resident in England from April 2006 till March 2013. Results There were 2,195 admissions to PICU for a median stay of 1.4 days. 59% were males and 51% aged 0-4 years. The fourth and fifth deprivation quintiles represented 61% (1,329) admissions and 73% (11) of the 15 deaths. Deaths were most frequent in 10-14 years age (n=11, 73%), with no deaths in less than 5 years age. 38% of admissions (828/2193) received invasive ventilation, which was more frequent with increasing deprivation (13% (108/828) in least deprived to 31% (260/828) in most deprived) and decreasing age (0-4-year-olds: 49%, 409/828). Conclusions This first multi-centre PICU study in England found that children from more deprived neighbourhoods represented the majority of asthma admissions, invasive ventilation and deaths in PICU. Children experiencing socioeconomic deprivation could benefit from enhanced asthma support in the community.

Paediatric admissions to a hospital in the United Arab Emirates

A prospective study was designed to assess the types of illness which resulted in hospital admission in Al-Ain, United Arab Emirates, and the background to the admission. The majority of children were admitted for the management of a respiratory condition, particularly asthma. Infections were the next major cause of hospital care. Management of the complications of thalassaemia was also an important reason for admission. The recognition of the importance of this disorder is necessary for future health care planning in the United Arab Emirates. The majority of children were regarded as having a disorder of medium severity at the time of their admission. The results are discussed in light of a similar United Kingdom study

963 Management of Acute Gallstone-Related Complications at Great Western Hospital (GWH): Re-Audit

Aim Gallstone related disease accounts for a third of the admissions to the Surgical Department. In June 2019, a clinical audit was undertaken at Great Western Hospital assessing the number of patients who underwent cholecystectomy, following initial diagnosis, in accordance to current guidelines. The results demonstrated a very low number of patients had cholecystectomy, within the targeted time frame, which led to the implementation of a dedicated operative “hot gallbladder” list weekly. In June 2020, we re-audit the service to evaluate the impact of the change implemented. Method A retrospective observational analysis of patients admitted to the Hospital in June 2020 with gallstone related disease. Data was collected using the Surgical on-call lists, these were analysed and patients selected according to the reason for admission, only gallstone related issues were considered in this analysis. Finally, via Medway, the time from admission to surgery was assessed. Results Despite the disruption in service provision due to COVID-19, the implementation of the “hot gallbladder” list led to a 10.7% increase in timely cholecystectomies, bringing the overall compliance to 14%. There was also a significant reduction in biliary relate re-admissions, from 58% to 37%. Despite 47.3% of patients were still awaiting surgery, the waiting list was reduced by 5.2% in only 1 year. Conclusions This study demonstrated that the implementation of the “hot gallbladder” list has improved the compliance with the current guidelines. The change has brought us in line with the national average of 15%, as estimated by RCSEng, therefore demonstrating the efficacy of the weekly list.

Unplanned Transfers From Intermediate Care Units to Intensive Care Units: A Cohort Study

This study evaluated unplanned transfers from the intermediate care unit (IMCU) to the intensive care unit (ICU) among urgent admissions. This retrospective, observational study was conducted in 2 ICUs and 1 IMCU. Three patterns of urgent admission were assessed: admissions to the ICU only, admissions to the IMCU only, and admissions to the IMCU with subsequent transfer to the ICU. Of 5296 admissions analyzed, 1396 patients (26.4%) were initially admitted to the IMCU. Of these, 172 (12.3%) were transferred from the IMCU to the ICU. Mortality was higher in patients transferred from the IMCU to the ICU than in the 3900 ICU-only patients (odds ratio, 3.22; 95% CI, 1.52-6.80). Most transfers from the IMCU to the ICU (135; 78.5%) were due to deterioration of the condition for which the patient was admitted. Patient transfers from the IMCU to the ICU were common, were associated with increased hospital mortality, and were mostly due to deterioration in the condition that was the reason for admission.

A community service review of the quality of inpatient discharge summaries from six inpatient wards at St Charles Hospital: an initial audit and quality improvement recommendations

AimsTo discuss whether Discharge summaries include important information to community mental health teams .To identify patterns and produce recommendations for change by Quality improvement methods .MethodA convenience sample was selected of the first 5 patient discharges from each of the 6 adult inpatient wards at St Charles Hospital. This represented a total of 30 reviewed summaries. Outcome items were generated following discussion with community psychiatric colleagues based on those aspects of an admission thought to be of most use to a community mental health team. These were; reason for admission, diagnosis, circumstances of admission, progress on the ward, risk assessment, physical health, legal status on discharge, discharge medication, discharge management plan, contact details. Basic identification was also recorded as was the ward and date of dischargeResult•Only 3.3% (1/30) of discharge summaries were complete of all items.•However 23.3% (7/30) were almost complete, failing to record only a single item, and a further 2 missing only 2 of 10 items. There was a bimodal distribution (Graph 1).•Seven (7/30) discharge summaries provided no information. Of these, four (4/7) discharge summaries were written in the progress notes directly, rather than using the discharge summary proforma.•The ‘reason for admission’ item was a clear low outlier with only 2/30 reporting this piece of information. For a number of cases, this was recorded unhelpfully as “in crisis”.ConclusionThere was limited evidence of systemic patterns,however some wards showed internal stark differences with some summaries complete or almost complete and others empty.The key findings from this report are the high number of discharge summaries which have either no responses to them (7/30). This may indicate that the writer did not know how to use the current discharge template, and therefore support with using this is indicated. For those with a very low (7/30) number of item responses, we might conclude that these discharge summaries were written by someone with knowledge of using the system, but for another reason did not complete the majority of the items asked, and for this reasons are not immediately clear. Similarly, as highlighted above the main low outlying result relates to the apparent widespread practise of writing “in crisis” as the ‘reason for admission’, unfortunately to community teams this is an unhelpful and self-evident response.

Compliance with regulations on recording inpatient obstetric medical records and its influencing factors at Tra Vinh obstetrics and pediatrics hospital in 2020

Background: Medical records are one of the important contents to ensure the monitoring, management of medical examination and treatment, storing and searching patient information, and scientific research. Objects and research methods: Cross descriptive research design with actual sample size of 255 HSBA. Results: The content of the general information section reached the lowest rate in the content of the administrative section of 83.9%. Other contents in this section have the rate of 90.9% - 99.8%. The average rate of general information is 92.9%. Contents of the medical history section, the proportion of satisfactory contents such as the reason for admission to the hospital (99.6%), the questioning part (96.3%) and the medical examination were quite high (97.8%), content of monitoring at the delivery chamber was only 73.7%. The average percentage of medical records meeting the requirements of the medical record part is 91.9%. Content inside medical records: The average rate is 91.1%. Conclusion: The medical records which have 85% to <100% of corrected items accounts for 98.1%. There should be specific instructions on how to record medical records at Tra Vinh Obstetrics and Pediatrics hospital Keywords: Medical record, completeness, timeliness

Assessment of Suicide Risks During the First Week Immediately After Discharge From Psychiatric Inpatient Facility

Background: The suicide rate in first week after psychiatric discharge is alarmingly high. Although a risk assessment prior to discharge is standard praxis, it can be difficult to take into consideration the obstacles that patient will meet once discharged. A follow-up-visit during the first week after discharge is an opportunity to reevaluate whether a person may be at risk of suicide.Aim: To determine how many patients, of those who were assessed, were evaluated to be at elevated risk of suicide during the first week after psychiatric discharge and secondarily to identify predictors of this and predictors for receiving a follow-up visit during first week after discharge.Methods: All patients discharged between March 1st 2018 to January 17th 2019 were offered a home visit including a systematic risk assessment. Socio-demographics and clinical variables were obtained from medical records and logistic regression analyses were used to identify predictors of a higher suicide risk assessment as well as receiving a follow-up visit.Results: Information from 1905 discharges were included. Of these, 1,052 were seen in follow-up meetings. Risk assessments was conducted in a total of 567 discharge procedures, of which 28 (5%) had an elevated risk of suicide. A history of suicide attempt, suicide risk having been the reason for admission, a first diagnosis of a psychiatric disorder was associated with an elevated risk of suicide after discharge.Conclusion: Follow-up visits could serve as an important tool to identify people whose suicidal risk were overlooked at discharge or exposed to severe stressors after discharge.