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Introduction Within the Geriatric Medicine department at the Lister Hospital, Stevenage, the timeliness and quality of discharge summaries had become a source of complaints. Both primary care practitioners and families reported documentation was inadequate or incorrect. This project aimed to improve the quality of these discharge summaries in accordance with standards generated from previous audit data. Through improving communication it was clear that patient care could be enhanced. Methods Each month 15 discharge summaries were selected at random for review. Alongside patient notes these summaries were appraised in regards to standard discharge summary requirements: timeliness of delivery; adequate description of admission; and documentation of the follow up plan. They were also appraised on documentation of specific requirements for older aged adults including cognitive status, mobility status, discharge destination, need for home help, Rockwood Frailty score and resuscitation and escalation plans. Interventions including informal communication with junior doctors, circulation of a 'Top Tips' sheet, generation of an information poster and dissemination of information at local teaching sessions, took place, and were assessed, over regular PDSA cycles. Results showed a clear, sustained improvement in the quality of the discharge summaries. At the end of data collection, 100% of discharge summaries contained an adequate description of admission and an appropriate follow up plan. There was also significant improvement in documentation of specific requirements. Where documentation was initially very limited, following interventions, most discharge summaries contained details pertaining to discharge destination, need for home support, mobility status and resuscitation and escalation plans. Conclusion The relatively simple interventions have been found to have a sustained improvement in the quality of discharge summaries from the Geriatric Medicine Department at Lister Hospital, Stevenage. Whilst more work needs to be done it is hoped that this will already have enhanced patient care. [ABSTRACT FROM AUTHOR]

Background: The population of the western world is rapidly ageing. 16% of deaths in the elderly are attributed to coronary artery disease. 69% of 30 day mortality following AMI in England is in the over 65s. As the population ages we can expect to see an increasing frequency of elderly patients presenting with ST elevation myocardial infarction (STEMI). We aim to compare long-term clinical outcomes in patients over 80 years with ST elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI) with patients less than 80 years.Search methods: This was an observational cohort study of 10,249 consecutive patients with STEMI treated with PPCI between 2005 and 2011 at 8 tertiary centres across London, UK. The primary end-point was all-cause mortality. Median follow-up was 3 years.Results: A total of 1051 octogenarians (10.3%) were treated with primary PCI. Octogenarian STEMI patients had a higher prevalence of cardiovascular risk factors. They were also more likely to have worse left ventricular systolic function (20.6% vs 15.1%, p = 0.007) and cardiogenic shock (7.9% vs 5.7%, p = 0.004). Mortality over the follow-up period was higher in the octogenarian group compared to the younger group (51.6% vs 12.8%, p < 0.0001). However octogenarians were less likely to undergo radial access (HR:0.82 (0.65–0.94)), and receive adjunctive therapies e.g. GPIIb/IIIa inhibitors (HR:0.60 (0.45–0.82), all of which were demonstrated to have a survival benefit in the octogenarian group.Conclusions: This data is consistent with previous evidence that 69% of 30 day mortality following AMI in England is in the elderly. Mortality benefit is demonstrated with use of adjunctive therapies, routinely used in the younger age group, suggesting the use of these therapies should be promoted in the older population. [ABSTRACT FROM PUBLISHER]