Emergency Departments In Ireland Research Articles

Hospital-presenting self-harm among older adults living in Ireland: a 13-year trend analysis from the National Self-Harm Registry Ireland.

To examine trends in rates of self-harm among emergency department (ED) presenting older adults in Ireland over a 13-year period. Population-based study using data from the National Self-Harm Registry Ireland. National hospital EDs. Older adults aged 60 years and over presenting with self-harm to hospital EDs in Ireland between January 1, 2007 and December 31, 2019. ED self-harm presentations. Between 2007 and 2019, there were 6931 presentations of self-harm in older adults. The average annual self-harm rate was 57.8 per 100,000 among older adults aged 60 years and over. Female rates were 1.1 times higher compared to their male counterparts (61.4 vs 53.9 per 100,000). Throughout the study time frame, females aged 60-69 years had the highest rates (88.1 per 100,000), while females aged 80 years and over had the lowest rates (18.7 per 100,000). Intentional drug overdose was the most commonly used method (75.5%), and alcohol was involved in 30.3% of presentations. Between the austerity and recession years (2007-2012), self-harm presentations were 7% higher compared to 2013-2019 (incidence rate ratio (IRR): 1.07 95% CI 1.02-1.13, p = 0.01). Findings indicate that self-harm in older adults remains a concern with approximately 533 presentations per year in Ireland. While in younger age groups, females report higher rates of self-harm, this gender difference was reversed in the oldest age group (80 years and over), with higher rates of self-harm among males. Austerity/recession years (2007-2012) had significantly higher rates of self-harm compared to subsequent years.

Frailty Knowledge, Use of Screening Tools, and Educational Challenges in Emergency Departments in Ireland: A Multisite Survey

BackgroundRecognizing frailty and providing evidenced-based management in busy emergency departments is challenging. Understanding the knowledge and educational needs of ED staff is important to design training that might improve patient outcomes. ObjectiveThis study aimed to explore frailty knowledge of ED staff, use of frailty screening instruments in Irish emergency departments, and educational challenges in the emergency department. MethodsA multisite survey of ED staff (different specialties) was conducted between April and September 2021. An anonymous online survey was distributed via email. Free-text sections were analyzed using content analysis. ResultsIn total, 168 staff (nursing, medical and allied health) participated, representing 9 of 26 Irish emergency departments (35%). Most respondents were nurses (n = 78, 46%). Less than half of respondents had received frailty identification training (n = 81, 48%). One-fifth of emergency doctors and nurses (20%) were unsure how to define frailty. Major barriers to ED frailty screening were resource deficits, insufficient diagnostic pathways from the emergency departments, and lack of education on suitable instruments. ConclusionsMost of the ED staff surveyed relied on clinical judgment rather than formal training in frailty identification. A high proportion reported poor knowledge and low confidence in recognizing frailty. Dedicated staff with frailty management expertise, bespoke education initiatives, and clearly defined frailty screening pathways may help address the issues identified.

Clinician consensus on “Inappropriate” presentations to the Emergency Department in the Better Data, Better Planning (BDBP) census: a cross-sectional multi-centre study of emergency department utilisation in Ireland

BackgroundUtilisation of the Emergency Department (ED) for non-urgent care increases demand for services, therefore reducing inappropriate or avoidable attendances is an important area for intervention in prevention of ED crowding. This study aims to develop a consensus between clinicians across care settings about the “appropriateness” of attendances to the ED in Ireland.MethodsThe Better Data, Better Planning study was a multi-centre, cross-sectional study investigating factors influencing ED utilisation in Ireland. Data was compiled in patient summary files which were assessed for measures of appropriateness by an academic General Practitioner (GP) and academic Emergency Medicine Consultant (EMC) National Panel. In cases where consensus was not reached charts were assessed by an Independent Review Panel (IRP). At each site all files were autonomously assessed by local GP-EMC panels.ResultsThe National Panel determined that 11% (GP) to 38% (EMC) of n = 306 lower acuity presentations could be treated by a GP within 24-48 h (k = 0.259; p < 0.001) and that 18% (GP) to 35% (EMC) of attendances could be considered “inappropriate” (k = 0.341; p < 0.001). For attendances deemed “appropriate” the admission rate was 47% compared to 0% for “inappropriate” attendees. There was no consensus on 45% of charts (n = 136). Subset analysis by the IRP determined that consensus for appropriate attendances ranged from 0 to 59% and for inappropriate attendances ranged from 0 to 29%. For the Local Panel review (n = 306) consensus on appropriateness ranged from 40 to 76% across ED sites.ConclusionsMultidisciplinary clinicians agree that “inappropriate” use of the ED in Ireland is an issue. However, obtaining consensus on appropriateness of attendance is challenging and there was a significant cohort of complex heterogenous presentations where agreement could not be reached by clinicians in this study. This research again demonstrates the complexity of ED crowding, the introduction of evidence-based care pathways targeting avoidable presentations may serve to alleviate the problem in our EDs.

162 Establishing a geriatric friendly Emergency Department in Ireland with a checklist and gap analysis

Abstract Background The population is ageing rapidly worldwide and in Ireland there has been a significant year on year increase of patients over sixty five presenting to the Emergency Department (ED). With the complexity of older patients, there is a focus on the creation of a department that caters to their needs. Methods A scoping literature review was performed to identify a checklist that could be utilised for establishing standards for a Geriatric Emergency Department. It was decided to use the ‘The Geriatric Emergency Department Guidelines’ written by the American College of Physicians et al1 as a model. This was then adapted to the Irish ED. Subsequently we applied this checklist to analyse the components that were in place within our own department. Results This study took place in a tertiary university hospital which sees over 50,000 patients per year. Within the ED there is a multi-disciplinary Geriatric Emergency Department Intervention Team (GEDI) in place and an Age Related Assessment Unit (ARAU) has recently been opened. Upon performing the gap analysis the majority of items on the checklist are in place with these resources. Those that are missing include certain members of the multidisciplinary team due to national issues with staffing and environmental constraints secondary to overcrowding within the ED. Despite these universal challenges, areas of improvement that are achievable in both the short and long term were identified. Conclusion An Emergency Department that caters to the older population is increasingly important. With the creation of a checklist and gap analysis demonstrating ease of use, essential components of care can be identified and readily implemented to create a department suitable for the older person.

The role of contextual factors in decision-making by General Practitioners on paediatric referral to the Emergency Department in Ireland: A Discrete Choice Experiment

A General Practitioner's (GP) decision to refer a patient to the emergency department (ED) requires consideration of a multitude of factors, and significant variation in GP referral patterns to secondary care has been recorded. This study examines the contextual factors that influence GPs when referring a paediatric patient with potentially self-limiting clinical symptoms to the ED.Utilizing a discrete choice experiment, survey data was collected from GPs in Ireland (n = 142) to elicit factors influencing this decision across five attributes: time/day of visit, repeat presentation, parents’ capacity to cope, parent requesting a referral, and access to a paediatric outpatient clinic/day unit.Using mixed logit models, all attributes were statistically significant, with repeat presentation and parents lacking the capacity to cope identified as the strongest contextual factors leading to the decision to refer to the ED.There has been limited exploration of this decision-making process and this study uses a robust design to identify and rank contextual attributes. Enhanced awareness of contextual factors on referral decision-making is crucial to understanding patterns of paediatric unscheduled healthcare and to planning services that respond to parent's and children's needs, whilst allowing GPs to make decisions in the best interest of the child.

Palliative care patient emergency department visits at tertiary university-based emergency department in Ireland

IntroductionPalliative care patients often present to the emergency department (ED) for various reasons e.g., acute illness, pain, altered mental status, and complications of therapy. Many visits involve less severe etiologies e.g., dyspnea, constipation, fear as patients approach the end of life, which may be more effectively and efficiently managed outside of the ED. The objective of this study is to identify and assess the frequency of presenting complaints, primary diagnosis, triage acuity, need for admission, in an Irish setting. MethodsA single-center retrospective, observational study of palliative care patients presenting to a tertiary-care university hospital emergency department in Dublin, Ireland. Study subjects were identified using the palliative care database and cross-referencing with the ED electronic patient record system database. The primary objective to identify potential areas to minimize ED visits and improve patient care and quality of life by elucidating reasons for visits. Outcome measures include presenting complaint, primary diagnosis, triage severity score, admission, discharge, death in hospital. Statistical analysis presented as descriptive statistics. ResultsFour-hundred-ninety-nine ED visits, 245 (49%) were male, and 254 (51%) were female with a mean age of 69.3 years-of-age. Most patients, 285 (57.1%) self-referred to the emergency department, with general practitioners and skilled nursing facility referrals 72 (14.4%) and 39 (7.8%), respectively. Primary diagnoses were various cancers, chronic obstructive pulmonary disease, congestive heart failure, and dementia. Major reasons for visits were dyspnea, pain, falls, trauma, fever, and altered mental status. Two-hundred-eighty-nine patients (58%) had an emergency severity index (ESI) score of 1 or 2 demonstrating a higher level of acuity. Three-hundred-fifty-eight (71.7%) were admitted, 141 (28.3%) discharged to home, 64 (12.8%) admitted patients died during their hospital admission. ConclusionsPalliative care patients utilize ED services not uncommonly. Though many of these patients presented with higher acuity triage scores, 42% had lower ESI scores and may be effectively managed outside of the ED. These data suggest developing mechanisms for these patients to be urgently evaluated in their homes or facilities obviating the need for an ED evaluation.

Are we there yet?' Distance to definitive care for Irish patients in the Better Data, Better Planning (BDBP) study.

Residing long distances from definitive care compromises patient safety and, in rural Ireland, travel distance to health care can be substantial, particularly in light of national General Practitioner (GP) shortages and hospital reconfigurations. The aim of this research is to describe the profile of patients attending Irish Emergency Departments (EDs) in terms of distance from GP care and definitive care in the ED. The 'Better Data, Better Planning' (BDBP) census was a multi-centre, cross-sectional study of n=5 urban and rural EDs in Ireland throughout 2020. At each site, all adults presenting over a 24-h census period were eligible for inclusion. Data were collected on demographics, healthcare utilisation, service awareness and factors influencing the decision to attend the ED, with analysis in SPSS. For n=306 participants, median distance to a GP was 3 km (range 1-100 km) and median distance to the ED was 15 km (range 1-160km). Most participants (n=167, 58%) lived within 5 km of their GP and within 10 km of the ED (n=114, 38%). However, 8% of patients lived ≥15 km from their GP and 9% of patients lived ≥50 km from their nearest ED. Patients living >50 km from the ED were more likely to be transported by Ambulance (p<0.05). Proximity to health services, by geographical location, is poorer in rural regions, so it's important that these patients have equity of access to definitive care. Therefore, expansion of alternative care pathways in the community and additional resourcing of the National Ambulance Service with enhanced aeromedical support is essential in the future.

The \u201cbetter data, better planning\u201d census: a cross-sectional, multi-centre study investigating the factors influencing patient attendance at the emergency department in Ireland

BackgroundInternationally Emergency Department (ED) crowding is a significant health services delivery issue posing a major risk to population health. ED crowding affects both the quality and access of health services and is associated with poorer patient outcomes and increased mortality rates. In Ireland the practising of “Corridor Medicine” and “Trolley Crises” have become prevalent. The objectives of this study are to describe the demographic and clinical profile of patients attending regional EDs and to investigate the factors influencing ED utilisation in Ireland.MethodsThis was a multi-centre, cross-sectional study and recruitment occurred at a selection of urban and rural EDs (n = 5) in Ireland throughout 2020. At each site all adults presenting over a 24 h census period were eligible for inclusion. Clinical data were collected via electronic records and a questionnaire provided information on demographics, healthcare utilisation, service awareness and factors influencing the decision to attend the ED.ResultsDemographics differed significantly between ED sites in terms of age (p ≤ 0.05), socioeconomic status (p ≤ 0.001), and proximity of health services (p ≤ 0.001). Prior to ED attendance 64% of participants accessed community health services. Most participants (70%) believed the ED was the “best place” for emergency care or attended due to lack of awareness of other services (30%). Musculoskeletal injuries were the most common reason for presentation to the ED in this study (24%) and almost a third of patients (31%) reported presenting to the ED for an x-ray or scan.ConclusionsThis study has identified regional and socioeconomic differences in the drivers of ED presentations and factors influencing ED attendance in Ireland from the patient perspective. Improved awareness of, and provision of alternative care pathways could potentially decrease ED attendances, which would be important in the context of reducing ED crowding during the COVID-19 pandemic. New strategies for integration of acute care in the community must acknowledge and plan for these issues as a universal approach is unlikely to be implemented successfully due to regional factors.

Consultation-Liaison Psychiatry Services in Ireland: A National Cross-Sectional Study.

Objective: This study aimed to describe the provision of consultation-liaison psychiatry (CLP, also known as liaison psychiatry) services in acute hospitals in Ireland, and to measure it against recommended resourcing levels.Methods: This is a survey of all acute hospitals in Ireland with Emergency Departments, via an electronic survey sent by email and followed up by telephone calls for missing data. Data were collected on service configuration, activity, and resourcing. Data were collected from CLP or proxy services at all acute hospitals with an Emergency Department in Ireland (n = 29). This study measured staffing and activity levels where available.Results: None of the services met the minimum criteria set out by either national or international guidance per 500 bed general hospital.Conclusions: CLP is a relatively new specialty in Ireland, but there are clear international guidelines about the staffing levels required to run these services safely and effectively. In Ireland, despite clear national guidance on staffing levels, no services are staffed to the levels suggested as the minimum. It is likely that patients in Ireland's acute hospitals have worse outcomes, and hospitals have unnecessary costs, due to this lack. This is the first study of CLP provision in Ireland and demonstrates the resource constraints under which most services work and the heterogeneity of services nationally.

Experiences of registered general nurses who care for patients presenting with self-harm to the emergency department in Ireland

BackgroundThere are a substantial number of self-harm presentations to emergency departments (EDs) yearly throughout Ireland. Nurses often struggle with the psychosocial nursing interventions required when caring for patients who present following self-harm. AimTo explore the experiences of registered general nurses (RGN) who care for patients presenting with self-harm to the ED in Ireland. MethodA qualitative descriptive study design was used to explore experiences of RGNs in caring for patients with self-harm in the emergency department. Data was collected using one to one interviews with a purposive sample of nine RGNs working in ED. Transcripts were analysed using Burnard’s thematic content analysis framework. ResultsThree themes emerged: 1) waiting for assessment/treatment in an unsuitable environment 2) caring for self-harming patients from a nursing perspective and 3) nurses’ perceptions of self-harming patients. ConclusionOverall ED nurses hold a positive attitude towards patients who self-harm but acknowledge that barriers and challenges do exist when caring for this patient group. This study highlights the need for specific training on caring for patients who present to ED following self-harm.

A snapshot in time: a 1-month review of all referrals to paediatric liaison psychiatry services in Dublin following emergency department presentation.

An emerging picture has seen increasing numbers of young people with mental health crisis attend paediatric emergency departments in Ireland. Following paediatric review, many are referred to in-house paediatric liaison psychiatry (PLP) services. This pilot study describes referral patterns and practice over a 1-month period across three Dublin centres. Case notes of all referrals to PLP were reviewed to extract relevant clinical and administrative data. For those admitted, costs associated with length of stay were estimated. Clinical profile, management and intra-hospital pathway differences were explored. Fifty-nine young people under 16 years presented to one of the three EDs with an acute MH presentation. The sample consisted of39 females (66%) with a mean age of13.7 years. The majority (n = 34, 58%) presented out of hours. A substantial portion of youths presenting(n = 37, 63%) were admitted, and had a mean duration of stay of 4.51 days. There were differences between hospitals in terms of frequency of presentation with self-harm, admission ratesand length of stay. Different PLP service configuration, staffing and funding streams may explain some of the differences observed across centres, although the findings should be interpreted with caution given the limited sample size. Standardisation of service provision and management is needed for PLP services. Additional community CAMHS resourcing is needed to support the development of alternative pathways for youth in need of urgent MH review.

The Experience and Meaning of Repeated Self-Harm Among Patients Presenting to Irish Hospital Emergency Departments

Background Self-harm is a global public health concern in terms of increasing morbidity in addition to causing considerable financial implications for the health sector. Patients presenting with a history of self-harm are at increased risk of self-harm repetition and suicide. Research exploring the patient’s experience of engaging in multiple self-harm episodes is lacking. This study aimed to explore the experiences and meaning of self-harm repetition, among patients who presented to three urban hospital emergency departments in Ireland. Method A subset of participants with a history of five or more self-harm attempts from an ongoing study, ‘Improving Prediction and Risk Assessment of Self-Harm and Suicide’ was selected for this article. Interview transcripts from four participants were selected for analysis using Interpretative Phenomenological Analysis. The qualitative software package NVivo 11 was used to store and organise data into themes. Results Data were analysed based on four participants (two males and two females) ranging in age from 25 to 56 years. Three of the four participants reported a history of early traumatic emotional, physical and sexual abuse. Four superordinate themes were generated from the data, ‘Significance of self-harm to the person’, ‘Trajectory of self-harm progression’, ‘Impact of abuse in adult life’ and ‘The road to recovery’. Conclusion Self-harm was used as a coping mechanism for participants who experienced distressing life events such as emotional and sexual abuse. The qualitative themes identified in this study have implications for the development of adequate medical and mental health support systems for patients with histories of repeated self-harm.

The experience of the non-medical prescriber in the emergency department in Ireland

Aim: this study set out to evaluate the position of the non-medical prescriber in the emergency department in Ireland. It aims to explore how the role is developing and determine possible barriers to role expansion. Results: six main themes were identified: the process of role development, changes in professional relationships, nurses' awareness of non-medical prescribing, role progression, the future of the role of the non-medical prescriber, and nursing management's understanding of the role. Conclusion: the findings suggest that despite major leaps in the progression of the non-medical prescriber role, many barriers remain. There have been great improvements in professional support from medical and pharmacy colleagues, but nurses themselves were identified as impeding the progression of the role.

35A Review of Out-of-Hours Access to CT-BRAIN/CT-ANGIOGRAM in “FAST” Positive Patients Presenting to Emergency Departments in Ireland

35A Review of Out-of-Hours Access to CT-BRAIN/CT-ANGIOGRAM in “FAST” Positive Patients Presenting to Emergency Departments in Ireland

Self-harm among the homeless population in Ireland: A national registry-based study of incidence and associated factors

BackgroundSelf-harm is a strong predictor of future suicide, but little is known about self-harm among the homeless population. The study aim was to estimate the incidence of self-harm among the homeless population and to assess factors associated with self-harm. MethodsData on self-harm presentations to 34 hospital emergency departments in Ireland were collected by the National Self-Harm Registry Ireland (NSHRI). Index presentations between 2010 and 2014 were included for the homeless and fixed residence populations. Incidence rates of self-harm were calculated using NSHRI data and census estimates. Factors associated with self-harm and repeated self-harm were analysed by multivariable-adjusted logistic regression. ResultsThe age-standardised incidence rate of self-harm was 30 times higher among the homeless (5572 presentations per 100,000) compared with those with a fixed residence (187 presentations per 100,000). Homeless people had significantly higher odds of being male (OR 1.86, 95%CI 1.56–2.23), presenting with self-cutting (vs. overdose, OR 2.15, 95%CI 1.74–2.66) and having psychiatric admission (vs. general admission, OR 2.43, 95%CI 1.66–3.57). Homeless people had higher odds of self-harm repetition within 12 months (vs. fixed residence, OR 1.46, 95%CI 1.21–1.77). The odds of repetition were significantly increased among homeless who engaged in self-cutting (vs. overdose, OR 1.76, 95%CI 1.17–2.65) and did not receive psychiatric review at index presentation (vs. reviewed, OR 1.54, 95%CI 1.05–2.26). LimitationsThe study only reflects self-harm presenting to hospital, and assumes no change in homelessness status after index presentation. Residual confounding may affect the results. ConclusionThere is a disproportionate burden of self-harm among the homeless. Targeted preventive actions are warranted.

Assessment and Management of Self Harm in Emergency Departments in Ireland: The National Clinical Programme

In 2014, more than 11,000 people came to Irish general hospital Emergency Departments following self-harm. It is known that up to 15% of patients who present following self-harm leave the Emergency Department (ED) without a bio-psycho-social (BPS) assessment of risk and need, and 17% will repeat their self-harm act within 3 months.Self-harm is the single biggest risk factor for completed suicide, increasing the risk of suicide 40-fold, as compared to the general population. Suicide is now the commonest cause of death for young men (aged 15-24 years) and middle aged men (45-54 years). Alcohol consumption is implicated in more than 37% of cases of self-harm and half of those who die by suicide have had a history of alcohol abuse in the final year of their lives.Diversity with regard to assessment procedures and management in health settings, as well as feedback from families bereaved by suicide, have led to repeated calls for the development and resourcing of an effective response for people who present to health services having engaged in self-harm.The aim of this National Clinical Care Programme (NCP) for the Assessment and Management of Patients Presenting to Emergency Departments following Self-harm is to develop a standardised and effective process for the assessment and management of individuals of all age ranges, including children, adolescents, adults and older adults, who present with self-harm to ED.It refers to the mental health/bio-psycho-social assessment and initial management of both risk and need following self-harm, in the acute hospital Emergency Department, from time of presentation to discharge.This NCP requires that all patients presenting to ED with self-harm (including suicidal ideation and intent) receive standardised triage, bio-psycho-social assessment and assertive follow up by skilled clinicians.Family/carers will be included in the assessment and follow up process. The quality of the programme will be monitored through a set of key metrics.The objectives of this programme are to:- Improve the assessment and management of all individuals who present to ED with self-harm- Improve access to appropriate interventions at times of personal crisis- Ensure rapid and timely linkage to appropriate follow-up care- Optimise the experience of families and carers in trying to support those who present with self-harm.The Clinical Programme started in December 2014 and has now been implemented in 16 of the targeted 21 hospitals in Ireland with 24 hour EDs. This was done by the deployment of Mental Health Clinical Nurse Specialists to the Emergency Departments. As well as assessment, their role has included on-site training for non-mental health ED staff to improve integrated care. Data reflecting the objectives of the Clinical Programme has been collected and will be presented and discussed.

The management of cellulitis in emergency departments: antibiotic-prescribing practices and adherence to practice guidelines in Ireland.

There is a lack of evidence to guide the management of cellulitis in the emergency department (ED). The primary aim of this study was to characterize antibiotic-prescribing practices for the treatment of cellulitis in Irish EDs. Secondary aims were to identify patient variables associated with the prescription of intravenous (i.v.) antibiotics and to describe the utility of three published guidelines for the management of cellulitis in the ED. This was a multicentre, prospective, observational cross-sectional study of consecutive patients presenting to six EDs in Ireland over a 1-month period (June 2012). In total, 117 patients were enrolled. Fifty-five percent of all patients (n=65) were referred from primary care, and emergency physicians prescribed i.v. therapy in 50% of patients (n=59) overall. Nonpurulent cellulitis accounted for 96.5% of cases (n=113). Flucloxacillin, either alone or with penicillin V, is the most commonly prescribed oral antibiotic in patients both referred from primary care and discharged from the ED. Flucloxacillin with benzylpenicillin is the most commonly prescribed i.v. Fever, increasing diameter of infection, and tinea pedis were associated with prescription of i.v. antibiotics by emergency physicians. The three guidelines examined in this study recommended oral antibiotic treatment for between 33-44% of patients who were treated with i.v. antibiotics by emergency physicians. In Ireland, current prescribing practices for CREST 1 and modified CREST 1 and 2 patients are poorly adherent to guideline recommendations.

A survey of dental school's emergency departments in Ireland and the UK: provision of undergraduate teaching and emergency care.

Emergency dental care is a vital service that new graduates should be prepared to offer. There are few published data relating to emergency dental care education. To assess this, and to gain a profile of accident and emergency departments (A&E) in dental schools, an online survey was sent to all of the dental schools in the Republic of Ireland and the UK. The survey addressed the school's A&E curriculum, teaching methods, undergraduate exposure and departmental details. The majority of A&E departments operated during normal working hours with a minority offering an out-of-hours service. Teaching of A&E topics, and undergraduate experience, vary significantly between schools. A&E departments were diversely named and exhibited significant regional variation. Approximately half employed a triage system. It is unclear what represents an adequate level of undergraduate exposure, and more research is required in this area. Assessment of undergraduates following time in clinic is an important component of any A&E module. We consider a reflective portfolio to represent a suitable form of assessment, and would recommend their introduction. In addition, we recommend that dental hospitals consider a nurse-led triage system.

A Prevalence and Management Study of Acute Pain in Children Attending Emergency Departments by Ambulance

Pain is the most common symptom in the emergency setting and remains one of the most challenging problems for emergency care providers, particularly in the pediatric population. The primary objective of this study was to determine the prevalence of acute pain in children attending emergency departments (EDs) in Ireland by ambulance. In addition, this study sought to describe the prehospital and initial ED management of pain in this population, with specific reference to etiology of pain, frequency of pain assessment, pain severity, and pharmacological analgesic interventions. A prospective cross-sectional study was undertaken over a 12-month period of all pediatric patients transported by emergency ambulance to four tertiary referral hospitals in Ireland. All children (<16 years) who had pain as a symptom (regardless of cause) at any stage during the prehospital phase of care were included in this study. Over the study period, 6,371 children attended the four EDs by emergency ambulance, of which 2,635 (41.4%, 95% confidence interval 40.2–42.3%) had pain as a documented symptom on the ambulance patient care report (PCR) form. Overall 32% (n = 856) of children who complained of pain were subject to a formal pain assessment during the prehospital phase of care. Younger age, short transfer time to the ED, and emergency calls between midnight and 6 am were independently associated with decreased likelihood of having a documented assessment of pain intensity during the prehospital phase of care. Of the 2,635 children who had documented pain on the ambulance PCR, 26% (n = 689) received some form of analgesic agent prior to ED arrival. Upon ED arrival 54% (n = 1,422) of children had a documented pain assessment and some form of analgesic agent was administered to 50% (n = 1,324). Approximately 41% of children who attend EDs in Ireland by ambulance have pain documented as their primary symptom. This study suggests that the management of acute pain in children transferred by ambulance to the ED in Ireland is currently poor, with documentary evidence of only 26% receiving prehospital analgesic agents.

Characteristics of hospital-treated intentional drug overdose in Ireland and Northern Ireland

ObjectivesThis study compared the profile of intentional drug overdoses (IDOs) presenting to emergency departments in Ireland and in the Western Trust Area of Northern Ireland between 2007 and 2012. Specifically...