Health Information And Quality Authority Research Articles

Expansion of Typical Values for Paediatric Patients in Ireland and Comparison with Published DRLs - Experiences of a Single Institution

IntroductionTo reduce the risks involved with ionising radiation exposure, typical values (TVs) and diagnostic reference levels (DRLs) have been established to help keep radiation doses ‘as low as reasonably practicable. TVs/DRLs provide standardised radiation dose metrics that can be used for comparative purposes. However, for paediatrics, such values should consider the size of the child instead of their age. This study aimed to establish and compare paediatric TVs for chest, abdomen and pelvis radiography. MethodsStudy methods followed processes for establishing paediatric DRLs as outlined by the Health Information and Quality Authority (HIQA). Kerma-area product (KAP) values, excluding rejected images, were retrospectively acquired from the study institution's Picture Archiving and Communications System (PACS). Paediatric patients were categorised into the following weight-based groupings (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg) and stratified based on the examination that was performed (chest, abdomen, and pelvis), and where it was performed (the different X-ray rooms). Anonymised data were inputted into Microsoft Excel for analysis. Median and 3rd quartile KAP values were reported together with graphical illustrations. ResultsData from 407 X-ray examinations were analysed. For the previously identified weight categories (5 to <15 kg, 15 to <30 kg, 30 to <50 kg, 50 to 80 kg), TVs for the chest were 0.10, 0.19, 0.37 and 0.53 dGy.cm2, respectively. For the abdomen 0.39, 1.04, 3.51 and 4.05 dGy.cm2 and for the pelvis 0.43, 0.87, 3.50 and 7.58 dGy.cm2. Between X-ray rooms TVs varied against the institutional TVs by -60 to 119 % (chest), -50 to 103 % (abdomen) and -14 and 24 %% (pelvis). ConclusionTVs in this study follow established trends with patient weight and examination type and are comparable with published literature. Variations do exist between individual examination rooms and reasons are multifactorial. Given that age and size do not perfectly correlate further work should be undertaken around weight-based TVs/DRLs in the paediatric setting.

Driving improvements in the quality, safety, consistency and coordination of care and support for children using health and social care services, through the collaborative development of national standards.&amp;nbsp;

Background: Ireland has national strategies and policies setting out the importance of integrated care and coordination of care and support between health and social care services, to enable children to get timely and appropriate care and support. Despite Government commitment to a coordinated approach, delivery of care and support to children continues to be inconsistent and fragmented. While children with complex needs are more likely to experience significant gaps and delays in the care and support they need, evidence shows that any child in need of care and support from a health or social care service is at risk of gaps and delays.&#x0D; The Health Information and Quality Authority (HIQA) and the Mental Health Commission (MHC) are the regulatory bodies for health and social care services, and mental health services, in Ireland. To promote and support greater integration and collaboration between health and social care services, HIQA and the MHC worked together to develop national standards for all health and social care services working with children. Throughout the standards development process, we collaborated with children and families with lived experience, and advocates and staff working in health and social care services.&#x0D; Methods: These evidence-based standards cover all health and social care services working with children, including healthcare, disability, mental health and children’s social services. They provide a shared framework for all services and aim to support them to work together in a coordinated and collaborative way to improve the experience and outcomes of children and families.&#x0D; The standards were informed by a literature review, and extensive stakeholder involvement including focus groups with 217 children, young people and families with lived experience, advocates, staff, inspectors, and policy-makers; and 130 responses to two public consultations. An Advisory Group representing key stakeholders and a Children’s Reference Group informed the standards. The Children’s Reference Group comprised of young people and family members with experience of health and social care to ensure active people involvement and engagement in design and implementation of the standards. Their input helped ensure the standards authentically reflected what children should expect from a health and social care service committed to child-centred care. &#x0D; &#x0D; Initiative: This is the first time a set of Irish national standards has been developed focused on the needs of all children across health and social care services. The standards are underpinned by the principles of a children’s rights-based approach, safety and wellbeing, responsiveness, and accountability. Presented in the child’s voice, they articulate what outcomes a child should expect and what a service needs to do to achieve these outcomes.&#x0D; Impact: These standards will help to drive quality, safety, consistency and coordination across health and social care services working with children, as all organisations and services will be operating to one set of consistent national standards. Although an important lever for change, we recognise that services will need tools to support implementation of the standards and we will work with the sector to identify and collaboratively develop relevant tools to support implementation of the standards in day-to-day practice.&#x0D;

Generic justification of medical exposure to ionising radiations in two European countries

Abstract The European Directive 2013/56/EURATOM aims to safeguard patients, members of the public and workers by setting out basic safety standards for protection against the dangers arising from exposure to ionising radiation. However, each European member state must consider how the Directive should be transposed at a national level and this has led to different organisational models being adopted. With regard to medical exposure to ionising radiation (MEIR), Ireland and Italy are interesting countries to compare because they have transposed the Directive in contrasting ways. Comparison of these models may highlight ways to harmonise approaches and improve efficiency. Case studies were prepared by reviewing national laws, analysing scientific documents and conducting interviews with managers of organisations assigned the responsibility for MEIR. The case studies focused on the generic justification (GJ) of MEIR, determining if the benefits of a radiological practice outweigh the risks, at a population level. Ireland implemented a centralised model by designating responsibility for the regulation of MEIR to an independent competent authority, the Health Information and Quality Authority (HIQA). The Health Technology Assessment Directorate in HIQA has built upon their experience in conducting evidence synthesis to inform health policy, but it may experience challenges as the single gateway for GJ decisions. In Italy, GJ is entrusted to national professional scientific radiological societies. The decentralised Italian model facilitates an immediate response to GJ applications from stakeholders, but the absence of strong national coordination may lead to duplication, loss of information and or partial knowledge of processes. Collaboration between European member states in the area of GJ of MEIR could support the standardisation of practices in Europe. This could be facilitated through the creation of a European working group. Key messages • The creation of a European working group focused on generic justification in radiation protection exposure is advocated. • A European working group would lead to less duplication of effort and a more streamlined process for generic justification.

The Fundamentals of Advocacy: Designing an online learning course for health and social care staff

Abstract Background The Health Information and Quality Authority (HIQA) develops national standards for health and social care services and tools to assist with implementation. In 2023, HIQA developed resources to help health and social care staff support advocacy in their work. This followed a recommendation of the COVID-19 Nursing Homes Expert Panel Report (2020). As this project is founded in human rights-based practice and in lessons learned from COVID-19, it is relevant across health and social care. Objectives We wanted to know: 1. the barriers to advocacy in health and social care services; 2. how best to address this. We found knowledge and understanding of advocacy to be a significant barrier, and therefore developed an online course. The course was informed by focus groups with health and social care staff, service-users and inspectors, and by user-testing. The objectives are that learners understand: • what advocacy is • the role of health and social care staff in advocacy • how to support people to have their will and preference met • the boundaries of their role as advocates, including any conflicts of interest • how to raise awareness of independent advocacy services, and when to support people to access these services. The course includes case studies, interviews and self-assessment. We are measuring impact through surveys, interviews and focus groups. Results Through stakeholder engagement and a review of evidence we identified knowledge and understanding as a significant barrier to advocacy. Since the course was launched in April 2023, 90% of participants report that, based on the course, they will make changes to the way that they work. A selection of these participants will be interviewed after six months to measure impact. Conclusions Our research identified a need to improve knowledge and understanding of advocacy among health and social care staff. The course evaluations to date have shown that the course has achieved this. Key messages • There is a need to improve knowledge of advocacy among health and social care staff. HIQA has developed an online learning course to address this, informed by extensive stakeholder engagement. • Advocacy is about supporting and empowering people to communicate their will and preference, secure their human rights, or represent their interests.

67 Audit of discharge summaries on a geriatric ward against the Health Information and Quality Authority (HIQA) National Standard

Abstract Background Discharge summaries are integral for safe transition of patient care. Complete, precise and succinct documentation can ensure improved quality of care and patient safety. Methods Retrospective data were collected from e-discharge summaries that were generated over a 7-month period from June-Dec 2022. A total of 20 samples were selected at random and assessed against the HIQA National Standard. The samples were compared to the physical medical records to countercheck if relevant information were present or omitted. There was a total of 78 outcomes measured as per the national standard. Results There were 8 (40%) discharge summaries with the complete clinical courses, in that they contained the main complaint, relevant clinical findings, relevant investigations results and the complete treatment courses. There were 4 (20%) summaries that had omitted documentation of inpatient complications or adverse events and 8 (40%) summaries had omissions present on medication prescriptions. There were 5 (25%) summaries whereby the list of stopped medications and the reasons for stopping the respective medications were omitted. There were 5 (25%) summaries with incomplete documentation of future plans. Only 4 (20%) discharge summaries had all the relevant information present. Conclusion Efforts to implement E-prescribing and electronic health records should be prioritised. The Irish Medical Council plans to introduce Entrustable Professional Activities (EPA), which are essential tasks that a trainee can be trusted to perform without direct supervision, once sufficient competence has been demonstrated. An entire EPA unit is dedicated to competent patient handover and discharge. A Discharge Summary Flowchart which highlights the inclusion of all the essential components of a complete discharge summary was introduced as a guide for the team. Finally, there is an ongoing continuous audit by Senior House Officers and Interns to assess the quality of discharge summaries after the recommendations have been implemented.

Lodgers, Boarders, Trolley Patients; A Growing Challenge in Emergency Departments (ED). Zero Tolerance for Trolleys or Zero Tolerance for Zero Trolleys; A Crude Examination of Progressive Capacity Issues in an Irish Emergency Department.

Introduction:The Health Information and Quality Authority (HIQA) Tallaght Report of 2012 found care of lodged admitted patients on ED trolleys was undermined in terms of quality and safety. HIQA advised the practice of lodging in ED adjacent hospital corridors should be discontinued entirely. This message was reiterated during the pandemic. Some lodged patients may spend the total duration of their admission on an ED trolley. ED has 15 Adult rooms, seven pediatric rooms, two minor injury rooms, one procedure room and two resus bays. The aim was to calculate the annual number of days when no admitted patients were lodged on trolleys in ED.Method:A descriptive study using data available from nationally issued reports on patients allocated to trolleys to the ED of Wexford General Hospital from January 2019-September 2022. Data was collected from national HSE daily SBAR reports. “Lodged patients” were those present in ED admitted but for whom no ward bed existed at 0745 daily.Results:Data was collected for 1,369 days, 90 days were excluded due to missing data sets, and data were included for 1,279 days. 290 days were recorded in 2019 with no lodged patients, 126 in 2020, 55 in 2021, and only 11 days in 2022 with no lodged patients. In 2022 the average number of lodged patients was six (Range 0-19). A total of 47 days had a lodged count of ten or greater.Conclusion:Despite a strong recommendation from HIQA to terminate the practice of ED patient lodging, this has not been implemented. During the COVID-19 pandemic, there had been a reduction in the overall number of patients visiting the ED. This contributed to the reduction in trolley-lodged patients however post-COVID pandemic there has been a surge in attendance with a clear deficit in bed capacity.

Exploring the facilitation of meaningful leisure activities in designated centres for older persons (nursing homes) in Ireland: A protocol for content documentary analysis of HIQA inspection reports.

Background: Nursing homes (NHs) in Ireland are regulated by the Health Information and Quality Authority (HIQA). Regulations for nursing homes under the Health Act 2007 (as amended) states that registered providers must provide residents with facilities for occupation and recreation, and opportunities to participate in activities in accordance with their interests and capacities (Government of Ireland, 2013 - S.I. No. 415/2013). Despite the proven benefits of engagement in meaningful activities, when an older person enters a NH, they often lose autonomy in occupational roles, and engagement in meaningful activities (Causey-Upton, 2015). In 2019, HIQA highlighted that there were relatively high levels of non-compliance in the area of residents’ rights (HIQA, 2020). Aim: Given the central role of leisure activities to older adults’ health and well-being, this study aims to understand how NH residents in Ireland were afforded opportunities for meaningful engagement in activities prior to and throughout the COVID-19 pandemic (2019 – 2021). This will be conducted through analysing a sample of publicly available HIQA inspection reports for NHs from 2019 – 2021. Methods: A content documentary analysis will be conducted using a qualitative deductive approach. Purposive sampling will be used to select 21 nursing home reports for the years 2019, 2020 and 2021. The sample will include nursing homes reported to be non-compliant, substantially compliant and compliant in the regulation of residents’ rights. An inspection report for each of these NHs (n=21) for the year 2019, 2020 and 2021 will create a sample of 63 reports for analysis. This sample will capture three time points for the 21 NHs pre-pandemic and throughout the pandemic.

4.A. Workshop: Lessons from the response to COVID-19 to inform strengthening of Essential Public Health Functions

Abstract Internationally, the COVID-19 pandemic has increased disease burden and mortality, impacted mental health and wellbeing and delayed diagnosis and treatment of non-COVID care. It has been argued that, had sufficient funding of Public Health, including pandemic preparedness, been in place historically, many shortcomings of the pandemic response could have been mitigated. Thus, strengthening Public Health systems is on the agenda of governments internationally. Areas of specific interest are, emergency preparedness, international cooperation and solidarity, promoting vaccination uptake, health equity and community engagement, health literacy and misinformation (particularly online), planning for future workforce requirements and harnessing digitalization in health to address communicable and non-communicable disease threats. The Essential Public Health Functions (EPHFs) provide a comprehensive, cost effective and operational approach to strengthening Public Health and are recognized by the WHO as key to building health system resilience. In a recent report, the WHO has proposed an approach to operationalizing the EPHFs, identifying key enablers that can be applied within specific country contexts. This workshop will describe the national and international research undertaken by the Irish Health Information and Quality Authority (HIQA) and the WHO at the request of the Department of Health to inform reform of the delivery model of Public Health in Ireland. HIQA and WHO will present the evidence base in terms of the value of EPHFs for health system strengthening, the findings of research to describe changes in Public Health structures and lessons learned in Ireland and across 12 countries during the COVID-19 pandemic, a description of the current state of delivery of the EPHFs within Ireland, and the results of a consultation survey distributed by the Department of Health in Ireland, investigating the experiences of organisations involved in the delivery of Public Health in light of the pandemic. The presenters will allow ample time for audience engagement and discussion with the expert panel to enable shared learning and to discuss the applicability of these findings to the reform and strengthening of the delivery of the EPHFs. The workshop objectives are to: • Describe the current evidence base in terms of the value of EPHFs for health system strengthening and the key enablers to support their application at country level. • Describe the recent changes and lessons learned regarding the delivery of the EPHFs during the COVID-19 pandemic in 12 countries. • Describe the delivery of the EPHFs in the Irish system in light of experience with COVID-19 and with awareness of current and future health system stressors. • Describe Public Health organisations’ experiences of delivering the EPHFs in Ireland in light of the pandemic. • Provide insights into how the delivery of the EPHFs could be reformed and strengthened for the future. Key messages • Lessons from the Public Health response to COVID-19, internationally and in Ireland will be discussed. • The workshop will provide a space to share ideas on reform and strengthening EPHF delivery.

TU5.11 Do surgical discharge summaries meet national standards? A closed loop clinical audit

Abstract Background High quality health care is information reliant. Access to high quality information in a timely manner is imperative in provision of quality patient care. A national standard for discharge summaries has been developed by the Health Information and Quality Authority (HIQA). A standard for surgical discharge letters is needed to avoid patient readmission, unnecessary presentation to primary care and to ensure continuity of care in the community. The aim is to assess the quality of surgical discharge summaries using the HIQA national Standard. To implement quality improvement strategies recommended by current research. To reassess the quality and close the audit loop. Methods For cycle one of audit, one month of discharge summaries in 2020 were generated across four consultant surgeons at the University Hospital Limerick. 33% of those were sampled evenly across consultants. 60 patient discharge summaries were audited. Training was implemented virtually. For cycle two of audit the same methodology was used, 43 discharge summaries were audited. Results Overall performance was 49%, improved to 69% following training. The worst performing category was future management, 20%, improved to 45%. The best performing categories were auto-populated, patient details 97% and primary care details, 100%. Patient medications were compliant in 25%, improving to 59%. Admission and discharge details were complete in 36% improving to 59%. Clinical narrative was present in 37% improving to 64%. Consultants had not signed off on any letters. Conclusions Surgical discharge summaries audited remain non-compliant with the national standard however, as research shows, NCHD training has improved performance across categories.

9.F. Workshop: Rapid evidence synthesis to inform the national response to the COVID-19 pandemic in Ireland

Abstract The Health Information and Quality Authority (HIQA) is an independent statutory authority in Ireland. Since March 2020, HIQA has been conducting evidence syntheses to support decision-making by the Irish National Public Health Emergency Team (NPHET). This work has informed guidance developed by national and international agencies such as the European Centre for Disease Prevention and Control (ECDC), Newfoundland and Labrador Center for Applied Health Research, Sciensano (Belgium), Alberta Health Services and Sante Publique France. The HIQA COVID-19 Evidence Synthesis Team draws on a broad range of evidence with expert clinical and public health input from HIQA's COVID-19 Expert Advisory Group, and produces a range of outputs to best suit the evidence needs of decision-makers. Across the world, agencies have had to adapt rapidly to provide up-to-date COVID-19 research evidence to decision-makers. Similarly, evidence users, including the public, have had to assimilate information on COVID-19 generated by such agencies. Significant challenges exist given the speed at which the evidence base is evolving on COVID-19, its sometimes conflicting nature and often poor quality, and the subsequent influence of its dissemination on policy and on individual behaviour and risk perceptions. This workshop describes the work of HIQA's COVID-19 Evidence Synthesis Team in its role to support the national response to the COVID-19 pandemic. The aim of this workshop is to share learnings on the structure, methodological approaches, and impact of a COVID-19 Evidence Synthesis Team. The presenters who all work on, or are affiliated with HIQA's COVID-19 Evidence Synthesis Team, will discuss a range of topics including the establishment of the team, the conduct of rapid evidence syntheses, and the impact and media coverage of the outputs. The presenters will each present their topic in turn and will allow ample time for engagement, and will use e-voting systems, to enable shared learning. The objectives for this workshop are to: Describe the establishment and organisation of a COVID-19 Evidence Synthesis Team Provide case examples of completed rapid evidence syntheses Examine the media coverage of selected outputs Present the findings of a an in-action evaluation Share learnings on the organisation of evidence synthesis teams, the conduct of rapid evidence syntheses and the subsequent communication of findings. As the pandemic moves into a new phase it is important that agencies involved in conducting, and using the findings of, evidence syntheses reflect on processes and impact to-date. Lessons learned from the COVID-19 evidence synthesis experience can inform the development of future evidence synthesis approaches as well as support future pandemic preparedness. There is a need to remain flexible and to innovate, and this workshop presents an ideal opportunity for a European public health audience to share experiences and ideas. Key messages The challenges and opportunities associated with conducting rapid evidence synthesis during a pandemic will be explored. This workshop will provide a space to share learnings and ideas.

Practice surrounding adverse events in residential care facilities in Ireland

Abstract Background Part of regulation of residential care facilities (RCFs) is the statutory responsibility of RCFs to notify the regulator about adverse events (AEs). Notifications typically include a description of practice in the aftermath of AEs and are an information source that can inform quality and safety improvements. The herein aim therefore was to analyse narratives in notifications received by the Health Information and Quality Authority (HIQA) in Ireland, to identify practice surrounding AE management and reporting. Methods A sample (n = 447) of notifications received by HIQA in 2018 was drawn from the Database of Statutory Notifications from Social Care in Ireland, 2013-2019. Inductive thematic analysis was conducted. Analysis was structured using the a priori agreed themes of: practice in the aftermath of an AE, system vulnerabilities and reporting practices. Results Two overarching themes were identified. The first, a chronological theme contained three sub-themes: pre event, including existing measures and situations, response to the event and continued response. Measures that are resident focused and follow policies and protocols in RCFs to prevent or mitigate the seriousness of AEs, were evident in the response and continued response. From this chronological order emerged the cyclical theory where short and longer term actions become part of the pre-event of future similar or repeated AEs. The second overarching theme, regulatory input, encapsulated procedural notes, requests for further information and notes on repetitive patterns. Conclusions RCFs respond to AEs with short and longer term actions with resident health and wellbeing as the focus. These actions in turn become part of the pre-event of future AEs. This cycle can be leveraged for quality improvement initiatives. Input from inspectors was positive and constructive but highlighted some regulatory burden. Dissemination of these results as good practice guides may improve management and reporting of AEs. Key messages Residential care facilities respond to adverse events with short and long term measures which feed into the management of future AEs. This cycle can be leveraged for quality improvement initiatives. Improvement opportunities in reporting practices were found. The development of good practice guides for residential care facilities and inspectors could reduce regulatory burden.

Media coverage of evidence outputs during the COVID-19 pandemic: findings from one national agency

BackgroundThe COVID-19 Evidence Synthesis Team within the Health Information and Quality Authority (HIQA) in Ireland produced a range of evidence-based reports on a broad range of public health topics related to COVID-19. These evidence outputs (EO) arose directly from questions posed by policy makers and clinicians supporting Ireland's National Public Health Emergency Team (NPHET). Findings from these EOs informed the national response to the COVID-19 pandemic in Ireland and influenced international public health guidance. How research findings are presented through domestic news can influence behaviour and risk perceptions.MethodsWe investigated traditional media coverage of nine COVID-19 EOs and associated press releases, published (April to July 2020) by HIQA. NVivo was used for conceptual content analysis of manifest content. ‘Core messages' from each evidence output were proposed and 488 sources from national and regional broadcast, print, and online media were coded at the phrase level. The presence of political and public health actors in coverage were also coded.ResultsCoverage largely did not distort or misrepresent the results of the EOs, however, there was variability in terms of what content was reported on and to what extent different stakeholders were involved in the contextualization of the findings of the EOs. Coverage appeared to focus more on ‘human-interest' stories as opposed to more technical reports (e.g. focusing on viral load, antibodies, testing, etc.). Selective reporting and the variability in the use of quotes from governmental and public health stakeholders changed and contextualized results in different manners than perhaps originally intended in the press release.ConclusionsOur findings provide a case-study of European media coverage of evidence reports produced by a national agency. Results highlighted several strengths and weaknesses of current communication efforts.

Mortality in residential care services for people with disabilities in Ireland

Abstract Background All-cause mortality is higher in people with disability than in people without disability. There is a need for descriptive epidemiological studies of deaths in people with disability to inform the development of public health interventions. All deaths in residential disability services in Ireland are notified to the Chief Inspector in the Health Information and Quality Authority (HIQA). These include notification of unexpected and expected deaths. The herein aim was to describe total, unexpected and expected deaths, and identify leading causes of death in residential disability services in Ireland. Methods Data on deaths in residential disability services in 2019 and 2020 were extracted from the Database of Statutory Notifications from Social Care in Ireland. The number of total deaths was calculated along with the percent and number of unexpected and expected deaths. The primary cause of death notified by services was coded using ICD-11 chapter headings. Results During 2019 and 2020, on average 9,115 people resided in residential disability services. Of these, 395 died, of which 45% (n = 178) were notified as unexpected. The leading causes of unexpected deaths were respiratory system diseases (35%, n = 62) and circulatory system diseases (18%, n = 32). The leading causes of expected death were respiratory system diseases (41%, n = 89) and cancers (31%, n = 67). Conclusions Almost half of deaths in residential disability services were notified as unexpected. Respiratory disease was the leading cause of both expected and unexpected death in people with disability residing in residential services in Ireland; three-fold the general Irish population (10.7%). Public health interventions aimed at reducing respiratory disease may reduce deaths in this group. Key messages In 2019 and 2020, nearly half of deaths of people with a disability residing in residential services were notified as unexpected. Death from respiratory diseases was substantially higher in people with disability living in residential services in Ireland than in the general population and warrants public health intervention.

A review of the inclusion of equity stratifiers for the measurement of health inequalities within health and social care data collections in Ireland

BackgroundHealth equity differs from the concept of health inequality by taking into consideration the fairness of an inequality. Inequities may be culturally specific, based on social relations within a society. Measuring these inequities often requires grouping individuals. These groupings can be termed equity stratifiers. The most common groupings affected by health inequalities are summarised by the acronym PROGRESS (Place of residence, Race, Occupation, Gender, Religion, Education, Socioeconomic status, Social capital). The aim of this review was to examine the use of equity stratifiers in routinely collected health and social care data collections in Ireland.MethodsOne hundred and twenty data collections were identified from the Health Information and Quality Authority (HIQA) document, “Catalogue of national health and social care data collections: Version 3.0”. Managers of all the data collections included were contacted and a data dictionary was requested where one was not available via the HIQA website. Each of the data dictionaries available was reviewed to identify the equity stratifiers recorded.ResultsEighty-three of the 120 data collections were considered eligible to be included for review. Twenty-nine data dictionaries were made available. There was neither a data dictionary available nor a response to our query from data collection managers for twenty-three (27.7%) of the data collections eligible for inclusion. Data dictionaries were from national data collections, regional data collections and national surveys. All data dictionaries contained at least one of the PROGRESS equity stratifiers. National surveys included more equity stratifiers compared with national and regional data collections. Definitions used for recording social groups for the stratifiers examined lacked consistency.ConclusionsWhile there has been much discussion on tackling health inequalities in Ireland in recent years, health and social care data collections do not always record the social groupings that are most commonly affected. In order to address this, it is necessary to consider which equity stratifiers should be used for the Irish population and, subsequently, for agreed stratifiers to be incorporated into routine health data collection. These are lessons that can be shared internationally as other countries begin to address deficits in their use of equity stratifiers.

4Ds: Documenting delirium diagnosis in discharge summary

IntroductionHospital discharge is a significant transitional phase with varying levels of needs and risks to be managed as lapses in communication commonly happen between secondary/tertiary and primary care.ObjectivesOur aim was to look at inclusion of delirium diagnosis in discharge summaries based on standards set by: 1. Health Information and Quality Authority (HIQA) National Standard for Patient Discharge Summary Information 2. NICE Guidelines on Delirium: prevention, diagnosis and management (CG 103)MethodsAll inpatients referred to Liaison Psychiatry from 9thJuly 2019 till 5th January 2020 were included, n = 729. Compared discharge summaries diagnoses to the internal Liaison Psychiatry ICD 10 consensus diagnosis and also HIPE coded diagnosis specifically for delirium.ResultsDelirium diagnoses and inclusion of delirium-specific information on discharge summarynProportion (n=112*) (%)Q1 Any F05 diagnosis coded by Liaison Psychiatry117100Q2 F10.4 diagnosis coded by Liaison Psychiatry00Q3 F1x.4 diagnosis coded by Liaison Psychiatry00Q4 Any F05, F10.4 and F1x.4 diagnosis coded in discharge summary on patient centre2320.5Q5 Was the word delirium or its synonym such as acute confusional state mentioned in the body of the discharge summary?6255.4HIPE Code Diagnosis6658.9ConclusionsHospital discharge summaries are essentially the main communication link between hospitalists and general practitioners to ensure continuity and future care of patients. Delirium diagnosis is not always recorded in discharge summaries. This is a risk to be managed. Education is vital to ensure awareness, prevention, early recognition and to ensure recording of diagnosis of delirium.

AB156. SOH21AS129. Do surgical department discharge letters meet the HIQA national standard?

Background: High quality health care is information reliant. Access to high quality and current information in a timely manner is imperative in the provision of quality patient care. A national standard for discharge summaries has been developed by the Health Information and Quality Authority (HIQA). A standard for surgical discharge letters is needed to avoid patient readmission, unnecessary presentation to primary care and to ensure high quality continuity of care in the community. The aim is to assess the quality of surgical discharge summaries at the University Hospital Limerick using the HIQA national Standard. To implement quality improvement strategies recommended by current research. To reassess the quality and close the audit loop.

Organizational structure and funding of health technology assessment agencies around the world

Aim : analyze the structure and funding of health technology assessment (HTA) agencies abroad. Materials and methods . Here, we review the organizational structure and funding of HTA agencies in Europe (Austria, Belgium, Germany, Ireland, the Netherlands, the United Kingdom, France, and Sweden), Canada and Australia. The relevant information was found on web-sites of HTA agencies, in the Medline database, and via the searching engines Yandex and Google; the search was conducted using the specific descriptors: «organizational structure of HTA agency», «funding of HTA agency», «pharmaceutical», «reimbursement», «healthcare decision-making», and «funding». Results. The identified HTA-agencies may have a status of either government-funded or nonprofit organization or a structural element of a governmental body. These hTa agencies are funded mainly from the national budget. The funding varies from €550 000 for Ireland to £63.1 mln (€70 million) for the National Institute for Clinical Excellence (NICE) in the UK. The number of employees in the reviewed HTA agencies varies from 6.8 full time employees (FTE) in the Health Information and Quality Authority (HIQA) in Ireland to 604 FTEs in the NICE.

Concerns for Small Hospitals in Rationalising Trauma Services: How Do We Ensure Enhanced Patient Services in Rural Areas?

Introduction:Trauma bypass has been introduced successfully worldwide with sustained reductions in mortality/morbidity. Analyzing structure, process, and outcome individually and collectively in systems has been found to focus improvement efforts in the audit cycle. The second Irish report on Major Trauma Audit (MTA) was published in December 2017. The median age of trauma patients in Ireland was 59, indicating an aging trauma population. 28% of patients required secondary transfer to complete their care. The mortality rate for 2016 was only 4%.Aim:To determine the ability of a road-based EMS system to bring patients from areas of Wexford County to proposed receiving centers within 60-90 minutes.Methods:Analysis took population centers in Wexford County, used Google Maps to estimate travel times at 3pm on a weekday, and proposed new trauma units and centers in Dublin, Cork, and Waterford.Results:In Wexford County urban centers, &gt;95% of patients will not reach a trauma unit in less than 60 minutes with current prehospital medical service capabilities. This even excludes response/on-scene time by prehospital practitioners in land-based EMS vehicles.Discussion:The proposed introduction of trauma bypass systems in Ireland should not disenfranchise patients with respect to the standards they are currently receiving. Gap analysis suggests considerable work is required within the ambulance service to increase critical skill levels of paramedics to support critical patients in the golden hour of their transfer. An increase in vehicles/resources will be required to ensure adequate staffing to meet Health Information and Quality Authority (HIQA) targets of 8 and 19 minutes for response acuity, and for longer durations of transport allied to dynamic resource deployment model as used by National Emergency Operations Centre (NEOC). Unintended consequences of system changes will need to be monitored carefully to avoid further adversely impacting recruitment of staff to bypassed Model 3 hospitals.

OP97 Cost-effectiveness Model Appraisal Guidelines For Health Technology Assessments In Ireland

IntroductionThe National Centre for Pharmacoeconomics (NCPE) assesses the cost-effectiveness of new drugs for which reimbursement by the healthcare payer, the Health Service Executive (HSE), is sought in Ireland. This research aims to create a systematic approach for the NCPE review group (RG) to assess each of the cost-effectiveness models submitted by the applicant by creating cost-effectiveness model appraisal guidelines.MethodsThe RG consists of clinical, statistical and health economic expertise. In order to systematically appraise the HTA submission, which includes a cost-effectiveness model, clear guidelines on how each of the members of the RG can work together are required. The current members of the RG in the NCPE were given a draft of the guidelines created by the primary author, and additional feedback and testing was performed using the expert experience of the team. A version of the guidelines was tested for its usefulness.ResultsThree checklists were created. The purpose of the first checklist is to evaluate if the cost-effectiveness model works correctly. The second checklist ensures that each of the assumptions included in the HTA dossier are the same as those included in the cost-effectiveness model. The final checklist validates the assumptions used in the cost-effectiveness model to ensure they are reasonable and appropriate for decision making. The final version of the checklists were validated by choosing cost-effectiveness models with known errors and/or discrepancies and testing that the issues were captured by the checklists.ConclusionsThese guidelines are not an exhaustive list of checks that should be performed, but are presented as the minimum requirements for consideration to be included with each RG assessment of the corresponding HTA submission. The guidelines will be constantly updated as the process evolves over time. The cost-effectiveness models should follow the National Health Information and Quality Authority (HIQA) Guidelines for the Economic Evaluation of Health Technologies in Ireland.

An audit of discharge summaries from secondary to primary care

Health is information-intensive. Reliable health care depends on access to this information in a timely and accurate manner. A standardised data set for clinical discharge summaries is essential to optimise the care the patient receives, particularly at discharge. The Irish Health Information and Quality Authority (HIQA) have recently developed a national standard for patient discharge summaries. Our aim was to assess the current quality of discharge summaries being received, determine the main areas of concern and establish the areas to improve patient safety. We studied 60 discharge summaries received at 3 general practices in the Mid-West of Ireland. We used HIQA "National Standard for Patient Discharge Summary" 2013 as our audit standard. Mandatory fields including Surname, Forename and date of birth were present in 100%, missing in 0%. The patient's address was missing in 7% (n= 4). Gender was missing in 82% (n= 50). Source of referral was missing in 52% (n= 32). No method of admission was documented in 70% (n= 43). Whilst principal diagnosis was documented in 100% (n= 60), no co-morbidities were documented in 28% (n= 17). No medication was documented in 30% (n= 18), and there was no documentation of medication changed in 39% (n= 24). Details of the person completing the discharge summary were incomplete as follows: 85% (n= 52) had no specialty documentation, 36% (n= 22) had no registration number and 38% (n= 23) had no contact number. This audit shows deficits in adhering to HIQA standards. These must be addressed as a matter of urgency.