Marie O’Connor

256Audit of the Orthogeriatric Service in Geriatric Patients Admitted with Acute Hip Fracture

Background: The evidence shows that a dedicated Orthogeriatric (OG) service reduces the length of stay, medical complications, in-hospital mortality and improves long-term survival1). The OG service was set up in a Level 3 HSE hospital as a three times a week pilot service with the aim of providing care towards geriatric patients admitted with acute hip fracture based on the six key standards of care set out in the Blue Book2). For this audit we were focused on three key standards: 1) Falls, 2) Bone protection and 3) Preoperative Geriatric review. Methods: We compared the data collected from the Hospital In-Patient Enquiry (HIPE) portal from October 2013 till March 2014 versus October 2016 till March 2017 when the service became operational. Patients were reviewed just once in their admission. The aim of the audit is to compare the Blue Book’s standards of care for each 6 months period that has been taken into study. Results: There were 53 patients admitted in the Oct 2013–March 2014 14 period vs. 79 admitted in the Oct 2016–March 2017 period. Female admissions were 74% and 70%, respectively. There were no patients assessed by a Geriatrician for falls for the Oct 2013– March 2014 period vs. 20% for the Oct 2016–March 2017 period. 28% vs. 43% were assessed for bone protection, respectively. When it comes to being assessed preoperatively by a Geriatrician, this was 9.4% and 35%, respectively. Discharges to either nursing home or convalescence increased by 9.3% for the Oct 2013–March 2014 period while for the Oct 2016–March 2017 period this figure increased only by 1.3%. Conclusion: The audit showed that with even a scarce short-hour OG service, improvements were seen across all the standards of care. We plan to use the above results to develop and implement a business plan for the OG service in this hospital.

214Isolated Nocturnal Hypertension Predicts Future Stroke Risk

Background: Essential and secondary hypertension are well documented major risk factors for cardiovascular and cerebrovascular events. This study explores the predictive value of isolated nocturnal hypertension for cerebrovascular deaths in a large patient cohort of referred hypertensive patients. Methods: 7,239 patients underwent 24 hour ambulatory blood pressure monitoring (ABPM). None of these patients were on antihypertensive medications at baseline. Mean age 63 years. Using a computerised national registry of death mortality outcome was ascertained. For this study we focused on stroke death only. The cohort was divided into 4 subgroups based on their 24 hour ABPM results. Category 1 = normotensive, category 2 = isolated daytime hypertension, category 3 = isolated nocturnal hypertension, category 4 = sustained 24 hour hypertension. The hazard ratios of stroke death for categories 2,3 and 4 were compared to category 1 ( normotensive patients). Results: Using cox multiple regression analysis after adjustment for age, sex, smoking history, body mass index, diabetes and cardiovascular history hazard ratios for stroke death in patients with isolated nocturnal hypertension was 1.91 (1.01–4.21). For isolated daytime hypertension hazard ratio is 1.38 (0.72–2.41) and for sustained hypertension 2.11 (1.12–3.94). Therefore, isolated nocturnal hypertension was an independent predictor of cerebrovascular mortality. Unsurprisingly sustained hypertension is also a predictor of cerebrovascular death. Conclusions: Nocturnal hypertension is a predictor of stroke risk. This study highlights the importance of 24 hour ABPM to identify and detect this high risk patient group which could potentially be missed otherwise. The reason a patient may have isolated nocturnal hypertension is multi-factorial, however other underling conditions, such as obstructive sleep apnoea need to be considered. Ultimately, from a clinician’s perspective, there needs to be increased vigilance and awareness of BP monitoring for nocturnal hypertension.