1
|
Marsh K, Avery A, Sahota O. 1179 4.5 TONNES OF FOOD WASTED ACROSS A HOSPITAL WARD: A SERVICE EVALUATION OF DIETARY INTAKE AND FOOD WASTE. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Abstract
Introduction
Malnutrition is a debilitating condition in hospitalised older people. There has been limited studies exploring dietary intake and oral nutritional supplement (ONS) compliance in these people. The purpose of this service evaluation was to observe daily energy and protein intake, plate waste and ONS compliance and to report food waste at ward level.
Methods
Three-day dietary (food-only) intake and plate waste of 19 older (≥ 65 years) people on a hospital trauma and orthopaedic (T&O) ward were assessed. Patients were categorised as ‘nutritionally well’ or ‘nutritionally vulnerable’ as per British Dietetics Association’s (BDA) Nutrition and Hydration Digest criteria. Dietary intake was calculated by a Dietitian and compared with adjusted BDA standards to exclude energy and protein from drinks. Ward plate and food trolley waste were weighed after lunch and supper for five days. Thirty-three ONS from 11 patients were collected before disposal and weighed.
Results
Mean age of the patients were 84 ± 9 years (9 female, and 10 male) with the most common injury hip fracture (68.4%). Mean (standard deviation, SD) intake for ‘nutritionally well’ was 1592 (257) kcal/day and 65.7(8.5) g/day protein and ‘nutritionally vulnerable’ (n= 15) 643 (354) kcal/day and 24.8 (14.0) g/day protein. Plate waste for ‘nutritionally well’ was 4.1 (5.8)% at main meals and 1.7 (3.4)% at pudding and for ‘nutritionally vulnerable’ 53.1 (26.6)% at main meals and 38.6 (32.2)% at pudding. Compliance to ONS was 28.3 (38.8)%. The combined mealtime plate waste weighed 6.2 (1.2) kg/day and food-trolley waste 6.2 (0.9) kg/day. This equates to approximately 4526kg/year (4.5T).
Conclusions
Energy and protein intake and compliance to ONS in older T&O patients is sub-optimal. Food waste is high and urgently needs addressing. Further, interventions are warranted to improve dietary intake in hospital and to explore the acceptability of alternative ONS food/drink styles.
Collapse
Affiliation(s)
- K Marsh
- Nottingham University School of Biosciences,
- Nottingham University Hospitals NHS Trust Department of Health Care of Older People,
| | - A Avery
- Nottingham University School of Biosciences,
| | - O Sahota
- Nottingham University Hospitals NHS Trust Department of Health Care of Older People,
| |
Collapse
|
2
|
Sahota A, Barbary R, Cameron M, Stewart AM, Sahota O. Safety of zoledronate in older patients at high risk of fracture with reduced renal function. Osteoporos Int 2022; 33:1823-1824. [PMID: 35599255 DOI: 10.1007/s00198-022-06427-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Affiliation(s)
- A Sahota
- Medical School, George Davies Centre, University of Leicester, Lancaster Rd, Leicester, UK
| | - R Barbary
- East Bridgford Medical Centre, Nottinghamshire Healthcare, Nottingham, UK
| | - M Cameron
- Depart HCOP, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A-M Stewart
- East Bridgford Medical Centre, Nottinghamshire Healthcare, Nottingham, UK
| | - O Sahota
- Depart HCOP, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- The Centre for Spinal Studies and Surgery, Nottingham University Hospital NHS Trust, Nottingham, UK.
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK.
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre (BRC), University of Nottingham, Nottingham, UK.
| |
Collapse
|
3
|
Bastounis A, Langley T, Davis S, Paskins Z, Gittoes N, Leonardi-Bee J, Sahota O. Comparing medication adherence in patients receiving bisphosphonates for preventing fragility fractures: a comprehensive systematic review and network meta-analysis. Osteoporos Int 2022; 33:1223-1233. [PMID: 35188591 PMCID: PMC9106630 DOI: 10.1007/s00198-022-06350-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/14/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Bisphosphonates are effective in preventing fragility fractures; however, high rates of adherence are needed to preserve clinical benefits. OBJECTIVE To investigate persistence and compliance to oral and intravenous bisphosphonates (alendronate, ibandronate, risedronate, and zoledronate). METHODS Searches of 12 databases, unpublished sources, and trial registries were conducted, covering the period from 2000 to April 2021. Screening, data extraction, and risk of bias assessment (Cochrane Collaboration risk-of-bias tool 1.0 & ROBINS-I) were independently undertaken by two study authors. Randomised controlled trials (RCTs) and observational studies that used prescription claim databases or hospital medical records to examine patients' adherence were included. Network meta-analyses (NMA) embedded within a Bayesian framework were conducted, investigating users' likelihood in discontinuing bisphosphonate treatment. Where meta-analysis was not possible, data were synthesised using the vote-counting synthesis method. RESULTS Fifty-nine RCTs and 43 observational studies were identified, resulting in a total population of 2,656,659 participants. Data from 59 RCTs and 24 observational studies were used to populate NMAs. Zoledronate users were the least likely to discontinue their treatment HR = 0.73 (95%CrI: 0.61, 0.88). Higher rates of compliance were observed in those receiving intravenous treatments. The paucity of data and the heterogeneity in the reported medication possession ratio thresholds precluded a NMA of compliance data. CONCLUSIONS Users of intravenously administered bisphosphonates were found to be the most adherent to treatment among bisphosphonates' users. Patterns of adherence will permit the more precise estimation of clinical and cost-effectiveness of bisphosphonates. TRIAL REGISTRATION PROSPERO 2020 CRD42020177166.
Collapse
Affiliation(s)
- A. Bastounis
- grid.412920.c0000 0000 9962 2336Division of Epidemiology & Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, NG5 1PB UK
| | - T. Langley
- grid.412920.c0000 0000 9962 2336Division of Epidemiology & Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, NG5 1PB UK
| | - S. Davis
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research, Regent Court (ScHARR), University of Sheffield, Sheffield, S1 4DA UK
| | - Z. Paskins
- grid.9757.c0000 0004 0415 6205School of Medicine, Keele University, Keele, ST5 5BG UK
- grid.500956.fHaywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent , Staffordshire UK
| | - N. Gittoes
- grid.6572.60000 0004 1936 7486Centre for Endocrinology, Diabetes and Metabolism (CEDAM), University of Birmingham, Birmingham, UK
- grid.412563.70000 0004 0376 6589Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH UK
| | - J. Leonardi-Bee
- grid.412920.c0000 0000 9962 2336Division of Epidemiology & Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, NG5 1PB UK
| | - O. Sahota
- grid.240404.60000 0001 0440 1889Queens Medical Centre (QMC), University of Nottingham, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH UK
| |
Collapse
|
4
|
Sahota A, Wallman J, Worrall R, Sahota O. 487 NOTTINGHAM (N-ICE) CREAM-A MORE NUTRITIOUS, PALATABLE AND PREFERRED HIGH PROTEIN, VITAMIN D FORTIFIED VANILLA ICE CREAM-A STEP TOO FAR? Age Ageing 2021. [DOI: 10.1093/ageing/afab116.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Oral Nutritional Supplement (ONS) drinks are commonly used to support nutritional intake in older people, however these are poorly consumed and frequently wasted. Fortified ice-cream offers a more acceptable ONS.
Methods
In collaboration with the University of Nottingham, Department of Food Sciences, we developed a high protein, vanilla ice cream (20 g/120 mL serving), fortified with vitamin D (400 IU)-Nottingham Ice (N-ICE) Cream. An anonymised Google consumer survey was untaken amongst older patients from the Nottingham Osteoporosis Patient Support group. We evaluated (on a rating scale of 1–10): Taste (1 unpleasant to 10 tasty), Mouthfeel (1 grainy to 10 smooth), Smell (1 unpleasant to 10 enticing), Appearance (1 off-putting to 10 inviting) and Colour (1 dull to 10 appealing) of the N-ICE Cream. Further comparison was made with an over-the-counter ONS drink Amyes Complete™ (similar in energy and protein content to N-ICE Cream).
Results
32 participants completed the consumer survey. The mean (SD) age of the patients was 79.1 (4.5) yrs. The mean (SD) score out of 10 for Taste was 8.95 (1.02), Mouthfeel 9.14 (0.98), Smell 8.86 (1.06), Appearance 8.95 (1.12) and Colour 9.10 (1.14). Overall acceptability was 8.92 (1.18). 64% of the participants were able to consume all of the 120 mL tub, 22% ¾, 10% ½ and the remaining only ¼ (4%). 30/32 participants preferred the Taste, 29/32 Mouthfeel and 28/32 the Smell of N-ICE Cream, when compared to the ONS drink, and overall if given a choice, 30/32 (94%) of the participants preferred N-ICE Cream over the Amyes Complete™ ONS drink. The retail cost of Amyes Complete was £2.50 and 28/32 of the participants said they would be willing to pay the same amount for N-ICE Cream.
Conclusion
N-ICE Cream is highly acceptable, nutritious and preferred by the consumer group evaluated when compared to an ONS Amyes Complete™ drink.
Collapse
Affiliation(s)
- A Sahota
- University of Leicester; University of Nottingham; Nottingham University Hospitals NHS Trust
| | - J Wallman
- University of Leicester; University of Nottingham; Nottingham University Hospitals NHS Trust
| | - R Worrall
- University of Leicester; University of Nottingham; Nottingham University Hospitals NHS Trust
| | - O Sahota
- University of Leicester; University of Nottingham; Nottingham University Hospitals NHS Trust
| |
Collapse
|
5
|
Wijayasiri P, Than HP, Munir M, Sahota O. 480 INFORMATION OVERKILL: IF THE WALLS ACROSS HOSPITALS WARDS COULD TALK. Age Ageing 2021. [DOI: 10.1093/ageing/afab116.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The walls across hospital wards are cluttered with posters, which, in some places, are peeling and staining with the years. Hospital management and well intention ward users dictate these displays, however their effectiveness in delivering essential information is rarely measured. We undertook a survey to establish: a) Whether posters are effective, b) What information ward users want, c) How they want information to be delivered.
Methods
100 participants (68 staff and 32 patients’ relatives) were surveyed across three 28 bedded wards for older people. They had to recall as many posters as possible then identify useful posters from a current list. They were asked about unmet information needs, other media that they would utilise and alternative uses for ward walls. Interventions were made on one ward based on initial findings: 1. An ‘Information for Relatives’ board was created, 2. A mural was installed. 20 relatives were asked to complete an anonymous form reviewing the board.
Results
Only 23% of participants were able to recall at least 3 posters. 34% could not find a single useful topic among the current posters. The most popular unmet information needs, among many, were ‘the discharge pathway’, ‘delirium’ and ‘falls’. Most participants said they would engage with alternative information media, suggesting leaflets, email and websites. A quarter felt walls should be for artwork, not posters. The ‘Information for Relatives’ board was well received. In the second survey, new unmet information needs were uncovered and, despite the new mural, 45% called for more paintings still.
Conclusions
Most people do not read the information on the walls on hospital wards. An appetite exists for alternative media. Paintings were earnestly called for at every point; a comforting ward environment should be part of the holistic care we aim to offer, especially for older patients.
Collapse
Affiliation(s)
| | | | - M Munir
- Nottingham University Hospitals
| | | |
Collapse
|
6
|
Ong T, Copeland R, Thiam CN, Cerda Mas G, Marshall L, Sahota O. Integration of a vertebral fracture identification service into a fracture liaison service: a quality improvement project. Osteoporos Int 2021; 32:921-926. [PMID: 33170309 DOI: 10.1007/s00198-020-05710-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
Integration of a vertebral fracture identification service into a Fracture Liaison Service is possible. Almost one-fifth of computerised tomography scans performed identified an individual with a fracture. This increase in workload needs to be considered by any FLS that wants to utilise such a service. INTRODUCTION This service improvement project aimed to improve detection of incidental vertebral fractures on routine imaging. It embedded a vertebral fracture identification service (Optasia Medical, OM) on routine computerised tomography (CT) scans performed in this hospital as part of its Fracture Liaison Service (FLS). METHODS The service was integrated into the hospital's CT workstream. Scans of patients aged ≥ 50 years for 3 months were prospectively retrieved, alongside their clinical history and the CT report. Fractures were identified via OM's machine learning algorithm and cross-checked by the OM radiologist. Fractures identified were then added as an addendum to the original CT report and the hospital FLS informed. The FLS made recommendations based on an agreed algorithm. RESULTS In total, 4461 patients with CT scans were retrieved over the 3-month period of which 850 patients had vertebra fractures identified (19.1%). Only 49% had the fractures described on hospital radiology report. On average, 61 patients were identified each week with a median of two fractures. Thirty-six percent were identified by the FLS for further action and recommendations were made to either primary care or the community osteoporosis team within 3 months of fracture detection. Of the 64% not identified for further action, almost half was because the CT was part of cancer assessment or treatment. The remaining were due to a combination of only ≤ 2 mild fractures; already known to a bone health specialist; in the terminal stages of any chronic illness; significant dependency for activities of daily living; or a life expectancy of less than 12 months CONCLUSION: It was feasible to integrate a commercial vertebral fracture identification service into the daily working of a FLS. There was a significant increase in workload which needs to be considered by any future FLS planning to incorporate such a service into their clinical practice.
Collapse
Affiliation(s)
- T Ong
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK.
- Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - R Copeland
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - C N Thiam
- Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - G Cerda Mas
- Consorci Sanitari de Terrassa, Terrassa, Spain
| | - L Marshall
- Department for Trauma and Orthopaedics, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - O Sahota
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- National Institute for Health Research (NIHR) Collaboration for Applied Health Research and Care (CLAHRC) East Midlands, Nottingham, UK
| |
Collapse
|
7
|
Sahota O, van Berkel D, Ong T, Drummond A, Hendrick P, Quraishi N, Salem K. Pelvic fragility fractures-the forgotten osteoporotic fracture! Osteoporos Int 2021; 32:785-786. [PMID: 33491138 PMCID: PMC8026450 DOI: 10.1007/s00198-021-05848-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/12/2021] [Indexed: 02/07/2023]
Affiliation(s)
- O Sahota
- Depart HCOP, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- The Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK.
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham, UK.
- National Institute for Health Research (NIHR) Collaboration for Applied Health Research and Care (CLAHRC) East Midlands, Nottingham, UK.
| | - D van Berkel
- Depart HCOP, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T Ong
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - A Drummond
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - P Hendrick
- Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - N Quraishi
- The Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - K Salem
- The Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| |
Collapse
|
8
|
Tarawneh AM, Sadanandan N, Salem KMI, Sahota O. 128 Prevalence of Older People Presenting Acutely to A Regional Spine Unit. Age Ageing 2021. [DOI: 10.1093/ageing/afab030.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
With ageing demographics, the number of older people is expected to rise exponentially over the next decade. With increasing numbers, the numbers of patients presenting to hospital will also increase. These patients have significant underlying comorbidities and thus further surgical interventions are more challenging.
Objective
To investigate the incidence of all in-patient referrals to the Nottingham Regional Spinal unit for patients aged 70 years and above over a 30-month period.
Methods
A retrospective 30-month review (Jan 2017-Aug 2019) of the clinical records of all in-patients’ referrals to the regional spinal unit (catchment population 4.5 million) for patients aged 70 years and above was undertaken. Patient demographics, co-morbidities, cause of referral, treatment modality (conservative vs. surgical), length of hospital stay, discharge destination (home vs. rehab) and mortality rates were collected and analysed.
Results
A total of 677 (Male: 335, Female: 342) in-patients’ referrals for patients aged 70 years and above were received. The mean age at presentation was 82.3 (±7.48) years. Trauma (low & high energy) was the most common cause of inpatient referrals (n = 448; 66.2%). Low energy trauma (insufficiency) fractures contributed to more than half of the total referrals (n = 256). Spondylodiscitis was the least common cause of referral (n = 34; 5%). Five-hundred forty-five patients were treated conservatively (80.5%). Average length of hospital stay was 16.7 days (range:1–282 days). Eighty-one of the discharged patients (13.5%) were transferred to rehabilitation after discharge, and the over-all 30-day mortality rate was 11.5% (n = 78).
Conclusion
Frail older people represent a significant workload to the regional spine unit. Adapting an ortho-geriatric model of care as with hip fracture care may be the optimal model of service delivery to improve outcomes for this patients group.
Collapse
Affiliation(s)
- A M Tarawneh
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust
| | - N Sadanandan
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust
| | - K MI Salem
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust
| | - O Sahota
- Queen's Medical Centre, Nottingham University Hospitals NHS Trust
| |
Collapse
|
9
|
Sahota A, Ong T, Kumar A, Simmonds L, Yoon WW, Salem K, Sahota O. Vertebroplasty for vertebral fragility fractures in the 'very elderly': experience from a regional UK spine unit. Osteoporos Int 2021; 32:395-396. [PMID: 33392717 DOI: 10.1007/s00198-020-05770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 11/26/2022]
Affiliation(s)
- A Sahota
- Medical School, University of Leicester, George Davies Centre, Lancaster Rd, Leicester, UK
| | - T Ong
- Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - A Kumar
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - L Simmonds
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - W W Yoon
- The Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - K Salem
- The Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - O Sahota
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK.
- The Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK.
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK.
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham, UK.
| |
Collapse
|
10
|
Griffiths R, Babu S, Dixon P, Freeman N, Hurford D, Kelleher E, Moppett I, Ray D, Sahota O, Shields M, White S. Guideline for the management of hip fractures 2020: Guideline by the Association of Anaesthetists. Anaesthesia 2020; 76:225-237. [PMID: 33289066 DOI: 10.1111/anae.15291] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2020] [Indexed: 12/26/2022]
Abstract
We convened a multidisciplinary Working Party on behalf of the Association of Anaesthetists to update the 2011 guidance on the peri-operative management of people with hip fracture. Importantly, these guidelines describe the core aims and principles of peri-operative management, recommending greater standardisation of anaesthetic practice as a component of multidisciplinary care. Although much of the 2011 guidance remains applicable to contemporary practice, new evidence and consensus inform the additional recommendations made in this document. Specific changes to the 2011 guidance relate to analgesia, medicolegal practice, risk assessment, bone cement implantation syndrome and regional review networks. Areas of controversy remain, and we discuss these in further detail, relating to the mode of anaesthesia, surgical delay, blood management and transfusion thresholds, echocardiography, anticoagulant and antiplatelet management and postoperative discharge destination. Finally, these guidelines provide links to supplemental online material that can be used at readers' institutions, key references and UK national guidance about the peri-operative care of people with hip and periprosthetic fractures during the COVID-19 pandemic.
Collapse
Affiliation(s)
- R Griffiths
- Department of Anaesthesia, Peterborough and Stamford Hospitals NHS Trust Peterborough, UK and Chair, Working Party, Association of Anaesthetists, UK
| | - S Babu
- Department of Anaesthesia, Warrington and Halton Hospitals NHS Trust, Warrington, UK
| | - P Dixon
- Department of Trauma and Orthopaedics, South Tyneside and Sunderland NHS Trust, Sunderland, UK and British Orthopaedic Association, Orthopaedic Trauma Society, UK
| | - N Freeman
- Department of Anaesthesia, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Hurford
- Department of Anaesthesia, Cwm Taf Morgannwg University Health Board and Chair, Welsh Frailty Fracture Network, UK, UK
| | - E Kelleher
- Department of Anaesthesia, University of Galway, Galway, Ireland
| | - I Moppett
- Division of Clinical Neuroscience, School of Medicine, University of Nottingham, UK.,Department of Anaesthesia, Nottingham University Hospitals, Nottingham, UK
| | - D Ray
- Department of Anaesthesia, Royal Infirmary Edinburgh and Honorary Clinical Senior Lecturer, University of Edinburgh, Edinburgh, UK
| | - O Sahota
- Department of Healthcare of Older People, Nottingham University Hospitals, Nottingham, UK and British Geriatrics Society, UK
| | - M Shields
- Department of Anaesthesia, Royal Hospitals, Belfast, UK
| | - S White
- Department of Anaesthesia, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| |
Collapse
|
11
|
Poynton-Smith E, Colwill E, Sahota O. 79 Do Medical Students Understand the Ward Environment? A Survey of Penultimate Year Medical Students Exploring How Well Healthcare Of Older People Placements Prepare Them for Working on Hospital Wards. Age Ageing 2020. [DOI: 10.1093/ageing/afz191.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Medical students are expected to know how to function on hospital wards; i.e. where to find things, other Health Care Professionals’ (HCPs’) roles, and how to use certain items of equipment (GMC, 2018). This ward-based knowledge indicates that a student is ‘ward smart’.1 Whilst being ‘ward smart’ is key for many aspects of medicine, it is particularly important for students learning geriatric medicine: older patients (who make up around 42% of all inpatients)2 are more likely to have communication difficulties and to require assistance. However, formal teaching in this area seems to be somewhat neglected, with students being left to ‘pick up’ this knowledge as they go along.3,4
In our sample of 41 students in their penultimate year (most of whom were undertaking their Healthcare of Older People placement), 98% did not know how to turn on a hearing aid and only 24% knew what a Waterlow score was. Furthermore, 88% did not know how to read an oxygen flowmeter, and only 59% knew where the CPR lever on the bed was situated.
This is a significant gap in knowledge: Students may not be as prepared to work in a ward environment as expected. Students felt that their understanding would be improved by teaching sessions, more time on wards, formal ward inductions, and shadowing other HCPs: only 41.5% had had a ward induction or introduction, and less than 20% had shadowed a nurse. We propose specific teaching/practical sessions for students during their Healthcare of Older People placement centred around patient communication and understanding the ward environment.
References
1. Walker, Wallace, Mangera, & Gill, The Clinical Teacher, 2017, 14(5), 336–9.
2. NHS Digital, 2018.
3. Prince, Bozhuizen, Van der Vleuten, & Scherpbier, Medical Education 2005; 39(7):704–12.
4. Monrouxe, et al., BMJ Open 2017; 7(1):e013656.
Collapse
Affiliation(s)
| | - E Colwill
- The University of Nottingham Medical School
| | - O Sahota
- The University of Nottingham Medical School
- Department of Healthcare of Older People, Queen’s Medical Centre
| |
Collapse
|
12
|
Tarawneh AM, Taqvi S, Salem KMI, Sahota O. 20 Cervical Spine Fragility Fractures in Older People: 5-Year Experience At A Regional Spine Centre. Age Ageing 2020. [DOI: 10.1093/ageing/afz183.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Cervical spine fractures are particularly prevalent in older people and commonly occur following a fall from standing height or less, in the presence of degenerative spinal disease. Atlanto-axial complex and odontoid process injuries are the most frequent type of fractures and are potentially life threatening. Published in-hospital and 1-year mortality rates in older people are eightfold higher than in younger patients. The aim of this study was to identify the incidence and characteristics of cervical spine fractures in older people presenting to a regional spine centre.
Methods
Clinical records and radiographs were retrospectively reviewed using our institutional registry covering a 5-year period. Data included patient age, gender, mechanism of trauma, level of fracture, stability of the fracture, treatment modality, imaging modality, and mortality rates.
Results
A total of 209 patients above the age of 70 with cervical spine fractures were treated in our centre from 2015-2019. The mean age of the patients at the time of injury was (82.4 ±7.5) years with the majority (n=117; 56%) being females.
One-hundred fifty-one patients (72.2%) experienced fractures in the atlanto-axial complex. Particularly, Dens fractures were the most commonly reported fracture (n=119; 56.9%). Most of the patients encountered stable cervical spine fractures (n=181; 86.6%) and these were managed by external immobilization with hard collar or halo vest.
Mechanism of trauma was divided into two main categories, low energy and high energy. Low energy trauma was the most common cause that lead to cervical spine fractures (n=169; 80.9%), compared to high energy trauma (n=40; 19.1%). CT scan and X-ray were the main imaging modalities utilized to detect cervical spine fractures. Whereas, MRI was only utilized in (n=51; 24.4%).
Overall mortality rate was (n=17; 8.1%) at 30 days. Out of which (n=1; 5.9%) was in a patient who was surgically treated while the remaining (n=16; 94.1%) were in those treated conservatively.
Conclusions
Cervical spine injuries in older people are clinically important. Low energy trauma particularly falls, were the main mechanism of cervical spine injury. Upper cervical spine injuries, mainly C2, is the most common cervical spine fracture and were most commonly detected using CT scan. External immobilization was our treatment of choice for most of the cervical spine injuries in the older people. These patients are very similar with respect to mean age, mechanism of injury and 30 days mortality rate as hip fracture patients.
Collapse
Affiliation(s)
- A M Tarawneh
- Centre for Spinal Studies and Surgery, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust
| | - S Taqvi
- Centre for Spinal Studies and Surgery, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust
| | - K M I Salem
- Centre for Spinal Studies and Surgery, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust
| | - O Sahota
- Centre for Spinal Studies and Surgery, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust
| |
Collapse
|
13
|
van Berkel D, Herschkovich O, Taylor R, Ong T, Sahota O. 88 The Truth Behind the Pubic Rami Fracture: Identification of Pelvic Fragility Fractures at A University Teaching Hospital. Age Ageing 2020. [DOI: 10.1093/ageing/afz193.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- D van Berkel
- Health Care of the Older Persons, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - O Herschkovich
- Health Care of the Older Persons, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R Taylor
- Health Care of the Older Persons, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T Ong
- Health Care of the Older Persons, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - O Sahota
- Health Care of the Older Persons, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| |
Collapse
|
14
|
Desai H, Hershkovich O, Ong T, Marshall L, Sahota O. 89 Poor Attendance for DXA in Older People with A Low Trauma Fragility Fracture: A 6 Year Data Analysis of the Nottingham Fracture Liaison Service. Age Ageing 2020. [DOI: 10.1093/ageing/afz193.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Hip Fractures are common and result in significant patient morbidity and increased mortality. Up to 40% of these patients have sustained a previous low-trauma fracture. The Department of Health advises that patients presenting with fragility fracture should have access to ‘Fracture Liaison Services (FLS)’. These are models of care which systematically identify patients at risk, assess bone health, treat patients (if needed) and follow patients up to support medication adherence.
Methods
Demographics of FLS patients between January 2012 and December 2017 was obtained retrospectively from the Nottingham University Hospitals FLS database. We examined DNA rates and further characteristics of these types of patients. Deprivation scores were deprived using the English indices of deprivation 2015 (1–Most deprived; 5-Least deprived). The 2016 cohort of patients were followed-up till January 2019 to assess for re-fractures.
Results
6528 high-risk patients were identified and referred to DXA. Mean (SD) age was 68±10.5 years [Females=5302 (81%)]. 1386 patients (21%) did not attend. High prevalence of non-attendance was in females [1032 patients (74%)] and the most deprived individuals [398 patients (29%)]. Females from the most deprived areas had the highest DNA rate [287 patients (29%)]. All eligible patients >75 years old were referred (n=1542 (100%), [Females=1284 (83%), non-attendance=473 (31%), non-attendance in females=390 (82%), highly deprived females=96 (25%)]. 826 patients were referred in 2016. Median follow-up time was 2.46 years (IQR 0.16–3.00 years). 52 patients (7%) re-fractured. 17 patients (33%) DNA their previous DXA scan [Females=12 patients (71%)].
Conclusions
Nottingham FLS have identified patients with fragility fractures that are high-risk for further fractures. Despite a dedicated FLS there is a DNA of 21%. Many patients that DNA are generally considered as having a high-risk of further fractures; females, older age and more deprived. Further studies are needed to explore why patients do not attend for bone density scanning.
Collapse
Affiliation(s)
- H Desai
- Department for Healthcare of Older People (HCOP), Queens Medical Centre, Nottingham University Hospital NHS Trust
| | - O Hershkovich
- Department for Healthcare of Older People (HCOP), Queens Medical Centre, Nottingham University Hospital NHS Trust
| | - T Ong
- Department for Healthcare of Older People (HCOP), Queens Medical Centre, Nottingham University Hospital NHS Trust
| | - L Marshall
- Department for Healthcare of Older People (HCOP), Queens Medical Centre, Nottingham University Hospital NHS Trust
| | - O Sahota
- Department for Healthcare of Older People (HCOP), Queens Medical Centre, Nottingham University Hospital NHS Trust
| |
Collapse
|
15
|
Ong T, Sahota O, Gladman JRF. The Nottingham Spinal Health (NoSH) Study: a cohort study of patients hospitalised with vertebral fragility fractures. Osteoporos Int 2020; 31:363-370. [PMID: 31696271 PMCID: PMC7010649 DOI: 10.1007/s00198-019-05198-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/15/2019] [Indexed: 01/14/2023]
Abstract
Patients hospitalised with vertebral fragility fractures were elderly, multimorbid and frail and lead to poor outcomes. Their hospital treatment needs to consider this alongside their acute fracture. A systematic organised model of care, such as an adaptation of orthogeriatric hip fracture care, will offer a more holistic approach potentially improving their outcomes. PURPOSE Patients admitted to hospital with vertebral fragility fractures are elderly and have complex care needs who may benefit from specialist multidisciplinary input. To date, their characteristics and outcomes have not been reported sufficiently. This study aims to justify such a service. METHODS Patients admitted with an acute vertebral fragility fracture over 12 months were prospectively recruited from a university hospital in England. Data were collected soon after their admission, at discharge from hospital and 6 months after their hospital discharge on their characteristics, pain, physical functioning, and clinical outcomes. RESULTS Data from 90 participants were analysed. They were mainly elderly (mean age 79.7 years), multimorbid (69% had ≥ 3 comorbid condition), frail (56% had a Clinical Frailty Scale score ≥ 5), cognitively impaired (54% had a MoCA score of < 23) and at high risk of falls (65% had fallen ≥ 2 in the previous year). Eighteen percent died at 6 months. At 6 months post-hospital discharge, 12% required a new care home admission, 37% still reported their pain to be severe and physical functioning was worse compared with their preadmission state. CONCLUSION Patients hospitalised with vertebral fragility fractures were elderly, multimorbid, frail and are susceptible to persistent pain and disability. Their treatment in hospital needs to consider this alongside their acute fracture. A systematic organised model of care, such as an adaptation of orthogeriatric hip fracture care, will offer a more holistic approach potentially improving their outcomes.
Collapse
Affiliation(s)
- T Ong
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK.
| | - O Sahota
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Derby Road, Nottingham, NG7 2UH, UK
| | - J R F Gladman
- Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospital NHS Trust, Derby Road, Nottingham, NG7 2UH, UK
- Division of Rehabilitation, Ageing and Wellbeing, University of Nottingham, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- National Institute for Health Research (NIHR) Collaboration for Applied Health Research and Care (CLAHRC) East Midlands, Nottingham, UK
| |
Collapse
|
16
|
Moppett IK, Rowlands M, Mannings AM, Marufu TC, Sahota O, Yeung J. The effect of intravenous iron on erythropoiesis in older people with hip fracture. Age Ageing 2019; 48:751-755. [PMID: 31127269 DOI: 10.1093/ageing/afz049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/26/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND anaemia following hip fracture is common and associated with worse outcomes. Intravenous iron is a potential non-transfusion treatment for this anaemia and has been found to reduce transfusion rates in previous observational studies. There is good evidence for its use in elective surgical populations. OBJECTIVE to examine the impact of intravenous iron on erythropoiesis following hip fracture. DESIGN two-centre, assessor-blinded, randomised, controlled trial of patients with primary hip fracture and no contra-indications to intravenous iron. METHOD the intervention group received three doses of 200 mg iron sucrose over 30 min (Venofer, Vifor Pharma, Bagshot Park, UK) on three separate days. Primary outcome was reticulocyte count at day 7 after randomisation. Secondary outcomes included haemoglobin concentration, complications and discharge destination. Eighty participants were randomised. RESULTS there was a statistically significantly greater absolute final reticulocyte count in the iron group (89.4 (78.9-101.3) × 109 cells l-1 (n = 39) vs. the control (72.2 (63.9-86.4)) × 109 cells l-1 (n = 41); P = 0.019; (mean (95% confidence intervals) of log-transformed data). There were no differences in final haemoglobin concentration (99.9 (95.7-104.2) vs. 102.0 (98.7-105.3) P = 0.454) or transfusion requirements in the first week (11 (28%) vs. 12 (29%); P = 0.899). Functional and safety outcomes were not different between the groups. CONCLUSIONS although intravenous iron does stimulate erythropoiesis following hip fracture in older people, the effect is too small and too late to affect transfusion rates. Trial Registry Numbers: ISRCTN:76424792; EuDRACT: 2011-003233-34.
Collapse
Affiliation(s)
- I K Moppett
- Anaesthesia and Critical Care Research Group, Division of Clinical Neuroscience, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - M Rowlands
- Department of Anaesthesia, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - A M Mannings
- Department of Anaesthesia, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - T C Marufu
- Department of Healthcare of Older Life, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - O Sahota
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J Yeung
- Warwick Medical School, University of Warwick, Warwick, UK
| |
Collapse
|
17
|
Fox C, Cross J, Penhale B, Hammond S, Backhouse T, Poland F, Shepstone L, Smith T, Sahota O, MacLullich A. 70PERI-OPERATIVE ENHANCED RECOVERY HIP FRACTURE CARE OF PATIENTS WITH DEMENTIA (PERFECTED): CLUSTER RANDOMISED CONTROL TRIAL. Age Ageing 2019. [DOI: 10.1093/ageing/afz059.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Fox
- School of Health Sciences, University of East Anglia
| | - J Cross
- School of Health Sciences, University of East Anglia
| | - B Penhale
- School of Health Sciences, University of East Anglia
| | - S Hammond
- Norwich Medical Scool, University of East Anglia
| | - T Backhouse
- School of Health Sciences, University of East Anglia
| | - F Poland
- School of Health Sciences, University of East Anglia
| | - L Shepstone
- Norwich Medical Scool, University of East Anglia
| | - T Smith
- Nuffield Centre, University of Oxford
| | | | | |
Collapse
|
18
|
Ong T, Sahota O, Gladman JRF. 91IS THERE A ROLE FOR AN ORTHOGERIATRIC MODEL OF CARE IN THE MANAGEMENT OF VERTEBRAL FRAGILITY FRACTURES IN HOSPITAL. Age Ageing 2019. [DOI: 10.1093/ageing/afy200.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Ong
- Division of Rehabilitation and Ageing, University of Nottingham
- Department for Healthcare of Older People, Nottingham University Hospitals NHS Trust
| | - O Sahota
- Department for Healthcare of Older People, Nottingham University Hospitals NHS Trust
| | - J R F Gladman
- Division of Rehabilitation and Ageing, University of Nottingham
| |
Collapse
|
19
|
Tan MY, Ong T, Sivam J, Al-Shuft H, Sahota O, Salem K. 32THE ROLE OF DYNAMIC SUPINE-SITTING SPINAL RADIOGRAPHS IN THE MANAGEMENT OF VERTEBRAL FRAGILITY FRACTURES ADMITTED TO HOSPITAL. Age Ageing 2018. [DOI: 10.1093/ageing/afy124.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Y Tan
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - T Ong
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - J Sivam
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - H Al-Shuft
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - O Sahota
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - K Salem
- Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust
| |
Collapse
|
20
|
Lim PN, Ooi LJ, Ong T, Neighbour C, Sahota O. 22PELVIC FRACTURES IN OLDER PEOPLE ADMITTED TO HOSPITAL: THE CLINICAL BURDEN. Age Ageing 2018. [DOI: 10.1093/ageing/afy124.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P N Lim
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
- Contributed equally
| | - L J Ooi
- Contributed equally
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - T Ong
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - C Neighbour
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - O Sahota
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| |
Collapse
|
21
|
Taib A, Ong T, Mulvaney E, Neale C, Strawther N, Peters C, Sahota A, Sahota O. 89CAN AN ICE CREAM BASED ORAL NUTRITIONAL SUPPLEMENT HELP ADDRESS THE ISSUE OF MALNUTRITION IN ORTHOGERIATRIC PATIENTS? Age Ageing 2018. [DOI: 10.1093/ageing/afy126.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Taib
- Central Manchester University Hospitals NHS Trust
| | - T Ong
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| | - E Mulvaney
- Department of Trauma and Orthopaedics, Nottingham University Hospitals NHS Trust
| | - C Neale
- Department of Catering, Nottingham University Hospitals NHS Trust
| | - N Strawther
- Dietetics and Nutrition, Nottingham University Hospitals NHS Trust
| | - C Peters
- Foundation Programme, Nottingham University Hospitals NHS Trust
| | - A Sahota
- Student Volunteer, Nottingham University Hospitals NHS Trust
| | - O Sahota
- Department of Healthcare for Older People, Nottingham University Hospitals NHS Trust
| |
Collapse
|
22
|
Kumar A, Ong T, Simmonds L, Sahota O, Yoon W. 19VERTEBRAL AUGMENTATION FOR OSTEOPOROTIC VERTEBRAL FRACTURES IN THE ‘OLDER-OLD’ PERSON: EXPERIENCE FROM A TERTIARY UK SPINAL UNIT. Age Ageing 2017. [DOI: 10.1093/ageing/afx055.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
23
|
Blain H, Masud T, Dargent-Molina P, Martin F, Rosendahl E, van der Velde N, Bousquet J, Benetos A, Cooper C, Kanis J, Reginster J, Rizzoli R, Cortet B, Barbagallo M, Dreinhöfer K, Vellas B, Maggi S, Strandberg T, Alvarez M, Annweiler C, Bernard PL, Beswetherick N, Bischoff-Ferrari H, Bloch F, Boddaert J, Bonnefoy M, Bousson V, Bourdel-Marchasson I, Capisizu A, Che H, Clara J, Combe B, Delignieres D, Eklund P, Emmelot-Vonk M, Freiberger E, Gauvain JB, Goswami N, Guldemond N, Herrero Á, Joël ME, Jónsdóttir A, Kemoun G, Kiss I, Kolk H, Kowalski M, Krajcík Š, Kutsal Y, Lauretani F, Macijauskienė J, Mellingsæter M, Morel J, Mourey F, Nourashemi F, Nyakas C, Puisieux F, Rambourg P, Ramírez A, Rapp K, Rolland Y, Ryg J, Sahota O, Snoeijs S, Stephan Y, Thomas E, Todd C, Treml J, Adachi R, Agnusdei D, Body JJ, Breuil V, Bruyère O, Burckardt P, Cannata-Andia J, Carey J, Chan DC, Chapuis L, Chevalley T, Cohen-Solal M, Dawson-Hughes B, Dennison E, Devogelaer JP, Fardellone P, Féron JM, Perez A, Felsenberg D, Glueer C, Harvey N, Hiligsman M, Javaid M, Jörgensen N, Kendler D, Kraenzlin M, Laroche M, Legrand E, Leslie W, Lespessailles E, Lewiecki E, Nakamura T, Papaioannou A, Roux C, Silverman S, Henriquez M, Thomas T, Vasikaran S, Watts N, Weryha G. A comprehensive fracture prevention strategy in older adults: The European union geriatric medicine society (EUGMS) statement. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
24
|
Ong T, Anand V, Tan W, Watson A, Sahota O. Physical activity study of older people in hospital: A cross-sectional analysis using accelerometers. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2015.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
Aw D, Thain J, Ali A, Aung T, Chua WM, Sahota O, Weerasuriya N, Marshall L, Kearney FC, Masud T. 45FRACTURE RISK PREDICTION AND TREATMENT THRESHOLDS USING FRAX, GARVAN AND QFRACTURE IN AN OSTEOPOROSIS CLINIC POPULATION. Age Ageing 2015. [DOI: 10.1093/ageing/afv108.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
26
|
Ong T, Tsintzas K, Daunt L, Sahota O. 47EFFECTS OF AGEING AND VITAMIN D DEFICIENCY ON VITAMIN D RECEPTOR (VDR) EXPRESSION IN HUMAN SKELETAL MUSCLE. Age Ageing 2015. [DOI: 10.1093/ageing/afv108.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
27
|
Ferguson E, Ollivere B, Sahota O. 66DISCHARGE LOCATION AFTER HIP FRACTURE - THE EFFECT OF POSTOPERATIVE COMPLICATIONS. Age Ageing 2015. [DOI: 10.1093/ageing/afv113.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
28
|
Aw D, Thain J, Ali A, Aung T, Chua W, Sahota O, Weerasuriya N, Marshall L, Kearney F, Masud T. P-003: Comparison of FRAX and QFracture use in an osteoporosis clinic population in determining whether to treat or not to treat in fallers versus non-fallers. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30106-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
29
|
Vass CD, Edwards C, Smith A, Sahota O, Drummond A. 7 * WHAT DO PATIENTS WEAR ON THEIR FEET? A SERVICE EVALUATION OF FOOTWEAR IN ELDERLY PATIENTS (STEP). Age Ageing 2015. [DOI: 10.1093/ageing/afv029.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
30
|
Abstract
UNLABELLED We completed a full audit cycle to assess waiting times for inpatients with suspected occult femoral neck fracture to get MRI scan, identify the causes of delay and implement the changes to reduce the waiting times. We have proved that inpatient MRI waiting times can significantly be reduced by a targeted approach. INTRODUCTION The timely management of hip fractures is now underpinned by NICE Guidance, June 2011. This includes a statement that magnetic resonance imaging (MRI) should be offered if occult femoral neck fracture is suspected and that MRI should be made available within 24 hours. We completed a full audit cycle: (1) analyse the time taken for inpatient MRI to be performed for suspected occult femoral neck fractures, (2) identify correctable reasons for delay, (3) develop and implement changes and (4) re-audit. METHODS Data was collected from the computerised radiology information system on consecutive patients between 01/04/2010 and 31/03/2012. This data was presented at a number of directorate audit meetings. Following the development and implementation of targeted improvements, a prospective re-audit was carried out between 01/08/2012 and 31/07/2013. RESULTS After the initial audit, various reasons of delay were identified. The correctable causes for delay were (1) duty radiologist not directly contacted by clinician to request urgent scan, (2) slow vetting and protocoling of electronic requests, (3) resistance to weekend scanning and (4) delay in completing MRI safety questionnaire. After implementing strategies to address these remediable causes of delay, the re-audit demonstrated a 16% improvement in patients scanned within 24 h. The mean waiting time to get an MRI was 2,025.4 min (SD 2,406.4) for the baseline audit and 1,374 min (SD 1,635.7) for the re-audit. Mean difference is 651.4 min (95% CI 85.21, 1,217.5; p = 0.0243). CONCLUSION MRI is a useful and sensitive tool to investigate occult femoral neck fracture. Inpatient MRI waiting times can significantly be reduced by a targeted approach which embodies improved team working.
Collapse
Affiliation(s)
- S Tiwari
- Department of Radiology, Nottingham University Hospitals NHS Trust, Derby Road, NG7 2UH, Nottingham, UK,
| | | | | | | | | |
Collapse
|
31
|
El-Sharkawy A, Sahota O, Vass C, Ljungqvist O, Maughan R, Lobo D. PP034-MON: Hydration and Outcome in Older Patients Admitted to Hospital. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50369-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
32
|
El-Sharkawy A, Bragg D, Watson P, Maughan R, Sahota O, Lobo D. PP003-MON: Dehydration in Nurses and Doctors On-Call is Associated with Impaired Cognitive Function. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
33
|
Tiwari S, Sprenger De Rover W, Sahota O, Moran C, Dawson S. 64 * AUDIT OF INPATIENT MRI WAITING TIMES FOR SUSPECTED OCCULT FEMORAL NECK FRACTURE. Age Ageing 2014. [DOI: 10.1093/ageing/afu036.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
34
|
Ong T, Tan W, Sahota O, Marshall L. 85 * ARE FRACTURES AND A DIAGNOSIS OF OSTEOPOROSIS IN THE ELDERLY RELATED TO SOCIAL DEPRIVATION. Age Ageing 2014. [DOI: 10.1093/ageing/afu038.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
35
|
Marshall L, Wong SM, Sahota O. 45 * INNOVATIVE INTRAVENOUS OSTEOPOROSIS AT HOME SERVICE. Age Ageing 2014. [DOI: 10.1093/ageing/afu036.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
36
|
Ong T, Tan W, Sahota O, Marshall L. 86 * THE RELATIONSHIP BETWEEN BODY MASS INDEX (BMI) AND FRACTURES IN THE ELDERLY. Age Ageing 2014. [DOI: 10.1093/ageing/afu038.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
37
|
|
38
|
Moorchilot R, Yielding RE, Smith DP, Morris RO, Sahota O, Attenborough A, Gordon AL. 2 * SYSTEMATIC MEDICAL ASSESSMENT BY A CONSULTANT GERIATRICIAN FOR PATIENTS UNDERGOING ELECTIVE SPINAL SURGERY. Age Ageing 2014. [DOI: 10.1093/ageing/afu036.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
39
|
Copeland R, Ong T, Sahota O. 83 * THE IMPACT OF LOW PERSISTENCE WITH OSTEOPOROSIS MEDICATION. Age Ageing 2014. [DOI: 10.1093/ageing/afu038.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
40
|
Ahmed S, Ong T, Sahota O. 65 * THE IMPACT OF SOCIOECONOMIC STATUS ON DEXA ATTENDANCE. Age Ageing 2014. [DOI: 10.1093/ageing/afu036.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
41
|
Aung T, Ali A, Coleman J, Maidment L, Tilford S, Sahota O, Masud T. A new approach for identifying patients at high risk for falls in emergency department. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
42
|
El-Sharkawy A, Sahota O, Maughan R, Lobo D. PP047-SUN HYDRATION AND OUTCOME IN OLDER PATIENTS ADMITTED TO HOSPITAL. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60092-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
43
|
Divyateja H, Prinsloo P, Ali A, Masud T, Pande I, Sahota O, Weerasurya N, Aung T, Chokkalingham K, Gupta P. Evaluation of the use of Denosumab for the treatment of osteoporosis at tertiary referral centre. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
44
|
Thain J, Vass C, Spick D, Sheldon W, DeVivo L, Sahota O, Alexander P. Visual impairment in elderly in-patients: A prospective survey. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
45
|
McGhee DJM, Royle PL, Counsell CE, Abbas A, Sethi P, Manku L, Narayan A, Clegg K, Bardai A, Brown SHM, Hafeez U, Abdelhafiz AH, McGovern A, Breckenridge A, Seenan P, Samani A, Das S, Khan S, Puffett AJ, Morgan J, Ross G, Cantlay A, Khan N, Bhalla A, Sweeting M, Nimmo CAMD, Fleet J, Igbedioh C, Harari D, Downey CL, Handforth C, Stothard C, Cracknell A, Barnes C, Shaw L, Bainbridge L, Crabtree L, Clark T, Root S, Aitken E, Haroon K, Sudlow M, Hanley K, Welsh S, Hill E, Falconer A, Miller H, Martin B, Tidy E, Pendlebury S, Thompson S, Burnett E, Taylor H, Lonan J, Adler B, McCallion J, Sykes E, Bancroft R, Tullo ES, Young TJ, Clift E, Flavin B, Roberts HC, Sayer AA, Belludi G, Aithal S, Verma A, Singh I, Barne M, Wilkinson I, Sakoane R, Singh N, Wilkinson I, Cottee M, Irani TS, Martinovic O, Abdulla AJJ, Irani TS, Abdulla AJJ, Riglin J, Husk J, Lowe D, Treml J, Vasilakis JN, Buttery A, Reid J, Healy P, Grant-Casey J, Pendry K, Richards J, Singh A, Jarrett D, Hewitt J, Slevin J, Barwell G, Youde J, Kennedy C, Romero-Ortuno R, O'Shea D, Robinson D, O'Shea D, Kenny RA, O'Connell J, Kennedy C, Romero-Ortuno R, O'Shea D, Robinson D, O'Shea D, Robinson D, O'Connell J, Topp JD, Topp JD, Warburton K, Simpson L, Bryce K, Suntharalingam S, Grosser K, D'Silva A, Southern L, Bielawski C, Cook L, Sutton GM, Flanagan L, Storr A, Charlton L, Kerr S, Robinson L, Shaw F, Finch LK, Weerasuriya N, Walker M, Sahota O, Logan P, Brown F, Rossiter F, Baxter M, Mucci E, Brown A, Jackson SHD, de Savary N, Hasan S, Jones H, Birrell J, Hockley J, Hensey N, Meiring R, Athavale N, Simms J, Brown S, West A, Diem P, Simms J, Brown S, West A, Diem P, Davies R, Kings R, Coleman H, Stevens D, Campbell C, Hope S, Morris A, Ong T, Harwood R, Dasgupta D, Mitchell S, Dimmock V, Collin F, Wood E, Green V, Hendrickse-Welsh N, Singh N, Cracknell A, Eccles J, Beezer J, Garside M, Baxter J. Clinical effectiveness. Age Ageing 2013. [DOI: 10.1093/ageing/aft016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
46
|
Vass CD, Sahota O, Drummond A, Kendrick D, Grainge M, Gladman J, Sach T, Avis M, O'Halloran AM, King-Kallimanis B, Kenny RA, Kumar A, Carpenter H, Morris R, Iliffe S, Kendrick D, Bamford C, Parry S, Deary V, Finch T, Cronin H, Savva G, O'Regan C, Donoghue OA, Kearney P, Kenny RA, Sutton GM, Hussain R, Bhangu J, King-Kallimanis B, Cunningham C, Kenny RA, Duggan E, Finucane C, Cronin H, O'Regan C, Savva G, Loughman J, Kenny RA, Donoghue OA, Horgan F, Savva G, Cronin H, O'Regan C, Kenny RA, Shipway DJH, Shipway MDH, Shah M, Jenkin RP, Wang Q, Chua EC. Falls, fractures and trauma. Age Ageing 2013. [DOI: 10.1093/ageing/aft019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
47
|
Morley D, Blackwell JR, Gallacher PD, Roberts PJ, Lim J, Baylis D, Ntani G, Syddall HE, Martin-Ruiz C, von Zglinicki T, Kuh D, Lord JM, Sayer AA, Cooper C, Thain J, Aw D, Marshall L, Sahota O, Chua W, Weerasuriya N, Aung T, Kearney F, Ali A, Masud T, Witham MD, Syddall HE, Dennison EM, Cooper C, McMurdo MET, Sayer AA, O'Mahony AM. Bones, muscles and rheumatology. Age Ageing 2013. [DOI: 10.1093/ageing/aft014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
48
|
Kendrick D, Sahota O, Vass C, Drummond A, Grainge M, Avis M, Gladman J. RANDOMISED CONTROLLED TRIAL TO REDUCE IN-PATIENT FALLS IN HOSPITALISED OLDER PEOPLE. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580b.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
49
|
Moppett IK, Wiles MD, Moran CG, Sahota O. The Nottingham Hip Fracture Score as a predictor of early discharge following fractured neck of femur. Age Ageing 2012. [DOI: 10.1093/ageing/afs092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
50
|
Abstract
UNLABELLED Data on the true acute care costs of hip fractures for patients admitted from care homes are limited. Detailed costing analysis was undertaken for 100 patients. Median cost was £9,429 [<euro>10,896], increasing to £14,435 [<euro>16,681], for those requiring an upgrade from residential to nursing home care. Seventy-six percent of costs were attributable to hospital bed days, and therefore, interventions targeted at reducing hospital stay may be cost effective. INTRODUCTION Previous studies have estimated the costs associated with hip fracture, although these vary widely, and for patients admitted from care homes, who represent a significant fracture burden, there are limited data. The primary aim of this study was to perform a detailed assessment of the direct medical costs incurred and secondly compare this to the actual remuneration received by the hospital. METHODS One hundred patients presenting from a care home in 2006 were randomly selected and a detailed case-note costing analysis was undertaken. This cost was then compared to the actual remuneration received by the hospital. RESULTS Median cost per patient episode was £9,429 [<euro>10,896] (all patients) range £4,292-162,324 [<euro>4,960-187,582] (subdivided into hospital bed day costs £7,129 [<euro>8,238], operative costs £1,323 [<euro>1,529] and investigation costs £977 [<euro>1,129]). Twenty-two percent of the patients admitted from a residential home required upgrading to a nursing home. In this group, the median length of stay was 31 days (mean 38, range 10-88) median cost £14,435 [<euro>16,681]. Average remuneration received equated to £6,222 [<euro>7,190] per patient. This represents a mean loss in income, compared to actual calculated costs of £3,207 [<euro>3,706] per patient. CONCLUSION The median cost was £9,429 [<euro>10,896], increasing to £14,435 [<euro>16,681], for those requiring an upgrade from residential to nursing home care at discharge. Significant cost differences were seen comparing the actual cost to remuneration received. Interventions targeted at reducing length of stay may be cost effective.
Collapse
Affiliation(s)
- O Sahota
- Department of Elderly Medicine, Nottingham University Hospitals, Nottingham, UK.
| | | | | |
Collapse
|