Hospitals In Ireland Research Articles

MS O01 - HPB Outcomes following Cholecystostomy Insertion for Acute Cholecystitis: A National Registry-based Study

Abstract Background Acute cholecystitis (AC) is a commonly encountered surgical emergency. In cases of severe AC or cholangitis, or in patients with significant comorbidities, percutaneous cholecystostomy (PC) may be employed. International data suggest PC is associated with significantly worse patient outcomes, but limited data exist in the Irish context. Method All patients with AC presenting to public hospitals in Ireland between January 2017 and July 2023 were identified using the National Quality Assurance and Improvement System (NQAIS). Data were collected on patient demographics including age, co-morbidities, length of stay/LOS, operative intervention, endoscopic intervention, critical care admissions, in-patient mortality, and readmissions. All patients managed with PC were identified, and their outcomes compared to patients managed without PC. Results In total, 20,886 patients were admitted with AC. 975 (5%) patients underwent PC and 19,911 patients (95%) were managed without percutaneous cholecystostomy. In comparison to non-cholecystostomy cohort, the PC cohort was older (median 72 v 58 years, p<0.001), less likely to be female (39% v 57% p<0.001), had proportionally longer LOS (<0.001), higher mortality rates (<0.001), were more likely to be admitted to critical care (<0.001), and more likely to be re-admitted to hospital within 30 days (<0.001). Conclusion Cholecystostomy insertion occurs in older patients with more comorbidities. These patients have higher in-hospital mortality rates, higher rates of critical care admission, longer LOS, and increased 30-day readmission rates.

Design and evaluation of a visual genomic explainer: a mixed-methods study

ObjectiveTo design and assess a visual genomic explainer focusing on plain language and engaging imagery. The explainer aimed to support doctors’ comprehension of complex genomic concepts and results and act...

Factors affecting implementation of a National Clinical Programme for self-harm in hospital emergency departments: a qualitative study

BackgroundA substantial number of people experiencing self-harm or suicidal ideation present to hospital emergency departments (EDs). In 2014, a National Clinical Programme was introduced in EDs in Ireland to standardise...

Do Early Supported Discharge Teams Increase the Proportion of Stroke Patients Discharged Directly Home from Acute Hospitals in Ireland?

Abstract Background Early Supported Discharge teams for stroke are associated with improved patient, rehabilitative outcomes, quality of life and potentially reduced mortality. Over the last 5 years the number of ESD teams and the proportion of patients discharge under their care has increased. What is unclear is to what extent has the growth in discharges with ESD support from acute hospitals represent additional discharges or patients who would have been discharged anyway but now receive rehabilitation and support post discharge. Methods Data on patients discharged directly home from the Irish National Stroke Audit (INAS) between January 2018 and December 2022 were analysed along with ESD data. This is the five-year period for which comprehensive data on ESD has been collected by INAS. Data used were available on public platforms and ethics approval was not necessary. Chi Square Statistics were performed, using proprietary software to compare proportions. Results Data on 23183 inpatient episodes were analysed, 57% of patients were male. INAS cases increased 34% from 3730 in 2018 to 4999 in 2022. Proportion of patients with unknown discharge destination (2.5%-2.9%) and who died (11.0%-10.8%) remained stable across the period. Proportion discharged home increased from 55.6% in 2018 to 59.5% in 2022 (Chi Sq 13.0, p=0.0003), (4.9% absolute, 7.0% relative). Proportion of ESD discharges increased from 3.7% to 9.8% of all patients (Chi Sq 117.3, p<0.0001) and from 6.7% to 16.5% of direct discharges home (Chi Sq 106.6, p<0.0001). However, direct discharges home without ESD support declined from 51.9% to 49.7% of the total population (Chi Sq 4.16, p=0.04). This suggests that, compared to 2018, 64% of ESD discharges in 2022 were additional and contingent on ESD availability. Conclusion ESD is an effective way of increasing direct discharges of people with stroke home from hospital. The proportion of patients with access to ESD remains low.

A comparison of efficacy of erector spinae plane block versus serratus anterior plane block plus subcostal transversus abdominus plane block for bariatric laparoscopic sleeve gastrectomy surgery: study protocol for a randomised clinical trial

BackgroundObesity is a rapidly growing global health concern. Limited long-term success of diet, behavioural modification and medical therapy have led to the increased performance of bariatric surgery. Laparoscopic sleeve gastrectomy, which permanently reduces the size of the stomach, has been shown to cause considerable weight loss, as well as improving or even eliminating obesity related medical comorbidities such as diabetes, obstructive sleep apnoea and hypertension. Unfortunately, this surgery can also result in significant postoperative pain which, when combined with the dangers of perioperative opioid administration for bariatric patients, can lead to a significantly reduced quality of recovery. Opioid-sparing analgesia has been widely recommended for perioperative bariatric patients, but research into the optimum regional analgesia approach for this surgery is lacking, with no trials to date comparing different regional analgesic techniques. This study protocol describes a randomised clinical trial aimed at answering this question, comparing the quality of recovery after laparoscopic sleeve gastrectomy for patients who receive erector spinae plane block, versus those who receive serratus anterior plane block plus subcostal TAP block.MethodsWe propose a prospective, randomised, blinded (investigator) clinical trial in a tertiary hospital in Ireland. Seventy patients presenting for laparoscopic sleeve gastrectomy will be randomised to two study groups—group A will receive bilateral erector spinae blockade; group B will receive left sided serratus anterior plane block plus subcostal TAP blocks. Both groups will receive the same dose of the same local anaesthetic and the different regional technique performed will be the only difference in their care. The primary outcome will be QoR-15 scores at 24 h postoperatively, a validated international tool for assessing a patient’s overall postoperative recovery.DiscussionRegional analgesia should be a mainstay of perioperative opioid-sparing analgesia where possible. This is especially important in the bariatric cohort who are particularly susceptible to the complications of perioperative opioid administration. To the best of our knowledge, this trial will be the first to compare efficacy of two different regional analgesia techniques for bariatric patients undergoing laparoscopic sleeve gastrectomy surgery.Trial registrationThis trial was pre-registered on clinicaltrials.gov, registration number NCT05839704, on March 5, 2023. All items from the World Health Organisation Trial Registration Data Set have been included.

Improving the management of hospital waiting lists by using nudges in letters: A Randomised controlled trial

ObjectiveA commonly adopted intervention to help to reduce wait times for hospital treatment is administrative validation, where administrators write to patients to check if a procedure is still required. The did not return (DNR) rate to validation letters is substantial. We tested whether the DNR rate was reduced by introducing nudges to validation letters. MethodsParticipants from eight public hospitals (N = 2855; in 2017) in Ireland were randomized to receive an existing (control group) or a redesigned validation letter including nudges (intervention group). ResultsParticipants in the intervention group were less likely not to return it than those in the control group, OR = .756, SE = .069, p = .002. Control and intervention group DNR rates were 23.97% and 19.24%. This is equivalent to 1 in 5 non-responders changing their behaviour because of the redesigned letter. ConclusionsThe redesigned letter increased patient compliance with the validation process. The redesign has subsequently been adopted by public hospitals in Ireland.

Impact of aesthetic surgery performed abroad on the Irish healthcare system

IntroductionAesthetic surgery tourism is a flourishing trend, and challenges often arise when patients return home with post-operative complications, necessitating follow-up care. MethodsBetween July 2021 and June 2023, we conducted a retrospective analysis of patients who presented with complications from aesthetic surgery tourism in two major teaching hospitals in Ireland. ResultsThirty-three patients with a mean age of 41 years were identified. Procedures were predominantly performed in Turkey (67%), followed by Lithuania (24%). Complications included wound dehiscence (n=22), infections (n=9), seroma (n=9), hematoma (n=2) and skin necrosis (n=1). A total of 27 operations were performed, with an average hospital stay of four days and a per-patient cost of €5 486. ConclusionComplications from aesthetic surgery abroad not only have a psychological and financial impact on the individuals involved but also strain our public healthcare system. Therefore, it is important for us, as medical professionals to advocate for our patients in order for them to make informed and safe decisions before seeking healthcare abroad.

Self-reported immune status and COVID-19 associated subjective cognitive functioning in post-COVID-19 syndrome: Examination of an Irish cohort.

Cognitive changes are very frequently reported by people with post-COVID-19 syndrome (PCS), but there is limited understanding of the underpinning mechanisms leading to these difficulties. It is possible that cognitive difficulties are related to immune status and/or low mood. The aim of the present study was to examine the relationship between immune status and cognitive functioning in PCS, while considering whether depression symptoms also influence this association. Participants were recruited in an online study of cognitive and psychological consequences of PCS, involving individuals attending a post-COVID clinic in an acute general hospital in Ireland, and a comparison sample of age- and sex-matched community controls who had also been infected with COVID-19 but had not experienced PCS. Participants with PCS (n=71) and community controls (n=50) completed the immune status questionnaire, Cognitive Failures Questionnaire (CFQ), Hospital Anxiety and Depression Scale (HADS), and the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F). Significant differences were observed between groups in terms of perceived immune status, perceived cognitive function, depression scores, and fatigue, with the "PCS" group reporting lower immune status, more cognitive difficulties, and higher levels of depression and fatigue. Regression analysis in the PCS group indicated that immune status and depression significantly contributed to variance in subjective cognitive functioning, with immune status remaining a significant predictor of cognitive functioning scores even when accounting for depression, fatigue, and other covariates related to PCS, such as Body Mass Index(BMI). Our findings suggest that subjective cognitive functioning is influenced by self-reported immune status in PCS, emphasising the importance of immune status, cognitive, and mood screening as part of routine clinical care in PCS.

Glucometrics utilisation in an urban teaching hospital in ireland: current practice and future aims.

Dysglycaemia in hospitalised patients is associated with poorer clinical outcomes, including cardiovascular events, longer hospital stays, and increased risk of mortality. Therefore, glucose monitoring is necessary to achieve best outcomes. This audit assesses use of point-of-care (POC) blood glucose (BG) testing in Tallaght University Hospital (TUH) over an 8-day period. It evaluates compliance with international and TUH glucose monitoring protocols and determines frequency of diabetes team consultations for inpatient adults. Data from an 8-day period (12/03/2023-19/03/2023) were extracted from the TUH COBAS-IT system and analysed. Invalid tests were excluded. Hyperglycaemia was defined as ≥ 10mmol/L and hypoglycaemia as ≤ 3.9mmol/L. Persistent hyperglycaemia was defined as two BG results of ≥ 10mmol/L. A chart review was conducted on adult patients with persistent hyperglycaemia to assess for HbA1C results, diabetes diagnosis, and diabetes consult. 3,530 valid tests were included and analysed. 674 individual patients had tests done. 1,165 tests (33.00%) were hyperglycaemic and 75 (2.12%) were hypoglycaemic. 68.25% of adults with persistent hyperglycaemia had an HbA1C test performed or documented within three months. 42.71% of inpatient adults with persistent hyperglycaemia and a known diabetes diagnosis received a consult from the diabetes team. Increased adherence to hospital protocols for testing HbA1C in adults with persistent hyperglycaemia could improve treatment and clinical outcomes. Increased diabetes team consultation could facilitate appropriate treatment and improve patient outcomes in persistently hyperglycaemic adult patient populations.

A descriptive analysis of drug-drug interactions and corresponding adverse drug reactions in multimorbid older inpatients: findings from the SENATOR trial.

Drug-drug interactions (DDIs) are prevalent among multimorbid and polymedicated older adults and can increase the risk of adverse drug reactions (ADRs), hospital admissions, and mortality. This study describes the incidence and prevalence of 66 clinically relevant DDIs and analyses the occurrence of 12 corresponding predefined ADRs in older inpatients enrolled in the SENATOR trial. The sub-study of the SENATOR trial that involved 1537 multimorbid older inpatients, recruited from 2016 to 2018 in six academic teaching hospitals in Belgium, Iceland, Ireland, Italy, Scotland, and Spain respectively, and analysed 66 potentially clinically significant DDIs. Descriptive analysis determined DDI and corresponding ADR prevalence/incidence. At baseline (median age: 78 [72, 84], 52.8% male), the prevalence of patients with DDIs was high (50.9%), increased during hospitalisation (55.2%) and reduced to 49.7% after 12weeks. The most common DDIs were: ≥ 2potassium reducing drugs (17.1%), ≥ 3centrally acting drugs (9.0%), and SSRI + loop/thiazide diuretic (7.2%). Of all participants, one-third experienced a prevalent (36.6%)/incident (35.8%) ADR. Major serum electrolyte disturbance had the highest incidence (10.7%)/prevalence (11.5%). Incident ADRs were more common in patients with DDIs (p = 0.013). A higher prevalence of new onset falls (p = 0.013), major constipation (p = 0.004), and major serum electrolyte disturbances (p = 0.006) was observed in patients with related and thus potentially causal DDIs. Clinicians should, be aware of DDIs and the involved drug classes that can lead to an increased rate of ADRs in older multimorbid inpatients. Regularly reevaluating the appropriateness of the frequently prescribed drug classesand initiating judicious deprescribing is recommended.

Management and patient outcomes following admission with acute cholecystitis in Ireland: A national registry-based study

IntroductionAcute cholecystitis is a common general surgical emergency, accounting for 3–10 % of all patients attending with acute abdominal pain. International guidelines suggest that emergency cholecystectomy is the treatment of choice for uncomplicated acute cholecystitis where feasible. There is a paucity of published data on the uptake of emergency cholecystectomy in Ireland. AimThe aim of this study was to evaluate the management of acute cholecystitis in Ireland and to establish the rate of emergency cholecystectomy performed. MethodsAll patients with acute cholecystitis presenting to public hospitals in Ireland between January 2017 and July 2023 were identified using the National Quality Assurance and Improvement System (NQAIS). Data were collected on patient demographics, co-morbidities, length of stay, operative intervention, endoscopic intervention, critical care admissions, in-patient mortality, and readmissions. Propensity score matched analysis and logistic regression were performed to account for selection bias in comparing patients managed with cholecystectomy and those managed conservatively. Results20,886 admission episodes were identified involving 17,958 patients. 3585 (20 %) patients underwent emergency cholecystectomy in total. 3436 (96 %) of these were performed laparoscopically, with 140 (4 %) requiring conversion to an open procedure, and common bile duct injuries occurring in 4 (0.1 %) of patients. In comparison to patients treated conservatively, patients who underwent cholecystectomy were younger (median 50 v 60 years, p < 0.001) and more likely to be female (64 % v 55 % p < 0.001). Following propensity score matched analysis, those who had an emergency cholecystectomy had reduced length of stay (LOS) (median 5 days (IQR 3–8) v 6 days (interquartile range (IQR) 3–10), p < 0.001) and fewer readmissions to hospital (282 (8 %) v 492 (14 %), p < 0.001). On logistic regression, age >65 (OR 1.526), CCI >3 (OR 2.281) and non-operative management (OR 1.136) were significant risk factors for adverse outcome. ConclusionUptake of emergency cholecystectomy in Ireland remains low, and is carried out on a younger, fitter cohort of patients. In those patients, however, it is associated with improved outcomes for cholecystitis compared to conservative management, including shorter LOS and reduced readmission rates for matched cohorts.

Antimicrobial Stewardship in Ireland (2010-2021): a scoping review protocol

Background Antimicrobial stewardship programmes (ASP) are essential in promoting responsible antimicrobial use, reducing antimicrobial resistance (AMR) and health care-associated infections. In 2009 the Strategy for the Control of Antimicrobial Resistance in Ireland (SARI), Hospital Antimicrobial Stewardship Working Group published guidance on antimicrobial stewardship (AMS) in hospitals. This paper presents a protocol for a scoping review which aims to examine the current literature to evaluate progress related to the implementation of the SARI (2009) guidance on antimicrobial stewardship in hospitals in Ireland. Methods This scoping review will be conducted in line with the five-stage methodological framework by Arksey &amp; O’Mally 2005. We will search the following databases (PubMed, CINAHL, Embase, Web of Science) and targeted websites for articles and reports for possible inclusion in our review. Studies pertaining to AMS undertaken or related to the Republic of Ireland from January 2010 until December 2021 will be included. We will include all study designs. We will map all selected publications to the recommendations of the SARI (2009) guidance document. The protocol follows the guidance of Peters et al., 2022. Two reviewers will independently screen studies and reports to assess eligibility with any discrepancies resolved by consensus discussion with a third reviewer. Results These will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR)and this checklist will be included when the scoping review is published. Conclusion This scoping review will map studies and reports to evaluate AMS in relation to national guidelines without restriction on study design or outcomes in the Republic of Ireland. This information has the potential to provide a valuable resource for the implementation of future AMS research and interventions.

Does a palliative medicine service reduce hospital length of stay and costs in adults with a life-limiting illness?-a difference-in-differences evaluation of service expansion in Ireland.

People approaching end of life account disproportionately for health care costs, and the majority of these costs accrue in hospitals. The economic evidence base to improve value of care to this population is thin. Natural experiment methods may be helpful in bridging evidence gaps with credible causal estimates from routine data, but these methods have seldom been applied in this field. This study aimed to evaluate the association between timely palliative care consultation and length of stay for adults with serious illness admitted to acute hospital in Ireland. In primary analysis we evaluated if timely palliative care receipt following emergency hospital inpatient admission impacted length of stay (LOS); in secondary analysis we verified if palliative medicine service (PMS) implementation co-occurred with any changes in in-hospital mortality, and we estimated cost differences associated with any change in LOS. This was a secondary analysis on routinely collected data for acute admissions to public hospitals in Ireland. We used difference-in-differences analysis to exploit the staggered implementation of PMS teams at acute public hospitals in Ireland between 2010 and 2015. We identified palliative care receipt following PMS implementation using ICD-10 codes, and we matched admissions involving a palliative care interaction to admissions in years prior to PMS implementation using propensity score weights. Our primary analytic sample included 4,314 observations, of whom 608 (14%) received timely palliative care. We estimated that the intervention reduced LOS by nearly two days, with an estimated associated saving per admission of €1,820. These analyses were robust to multiple sensitivity analyses on regression specification, weighting strategy and site selection. Proportion of admissions ending in death did not change following PMS implementation. Prompt interaction between suitable patients and palliative care can improve the quality and efficiency of care to this population. Many patients receive palliative care later in the hospital stay, which does not yield cost-savings. Future studies can extend and strengthen our approach with better data, as well as using different methods to understand how to trigger palliative care early in a hospital admission and realise available gains.

Fast-track knee pathway: A cost effective, quality improvement initiative for knee osteoarthritis

BACKGROUND: The prevalence of knee osteoarthritis is increasing due to population growth, ageing and other risk factors. However, the majority of patients can successfully manage their symptoms using conservative management strategies with only a minority requiring surgery. In 2019, a patient waited four years to be seen if deemed routine for an elective orthopaedic out-patient appointment in a large acute hospital in Ireland. OBJECTIVE: To establish a Fast-Track Knee Pathway in an Irish healthcare setting, creating a more efficient channel into elective orthopaedics for patients requiring surgical intervention whilst providing community-based care for those with non-surgical needs. METHODS: a) Establishment of a dedicated community-based physiotherapy and dietetic service for knee osteoarthritis, b) implementation of a Rapid Access Knee Clinic in elective orthopaedic clinics, and c) economic evaluation of the Fast-Track Knee Pathway’s cost effectiveness compared with the traditional pathway. RESULTS: 403 patients with knee osteoarthritis were removed from physiotherapy waiting lists with 9 patients requiring referral onwards to the Rapid Access Knee Clinic. On average there was a 64% reduction in wait time to access an orthopaedic consultant across 4 pilot sites. An incremental cost-effectiveness ratio of € 22,535.03 per QALY was estimated. Comparing this to the national accepted threshold of € 45,000 per QALY the Fast-Track Knee Pathway can be considered cost-effective. CONCLUSION: The Fast-Track Knee Pathway provides a fully integrated pathway of care for patients with knee osteoarthritis, facilitating earlier access to orthopaedic intervention. An economic evaluation concluded that this model of care is more cost-effective than the traditional pathway.

Assessment of pre-, peri-, and post-surgical practices for elective colorectal patients in a model 4 hospital in Ireland

IntroductionThe ERAS protocol is a set of international guidelines established to expedite patients’ discharge after colorectal surgery. It does this by aiming to prevent postoperative complications early, and return the patient to normal function allowing earlier discharge. Complications such as PONV, DVT, ileus and pain are common after surgery to name a few, and delay discharge. Early treatment and prevention of these complications however is suggested to aid a patients’ return to home at earlier rates than traditional practice.MethodsA prospective chart review and questionnaire was performed on patients undergoing colorectal surgery in UHL in a 6-month period from February to September 2023. Patients were approached on the 3rd day postoperatively and informed about the project. Exclusion criteria included patients who went to HDU or ICU postoperatively.ResultsIn total, 33 patients were recruited. A target of greater than 70% compliance was reached for a variety of the elements of the ERAS protocol such as laparoscopic surgery, preoperative assessments, nutritional drinks, LMWH, oral intake within 24 h of surgery, and intraoperative antiemetics. Unsatisfactory compliance was found with documentation of postoperative antibiotics use of preoperative gabapentin.ConclusionUHL has a satisfactory compliance of over 70% with a large variety of elements of the ERAS protocol. Areas of improvement required include postoperative antibiotic and preoperative gabapentin usage. With the collective effort of the multidisciplinary team, along with education, the ERAS protocol can successfully be applied and implemented in a model 4 hospital in Ireland.

Lessons From a Crisis: A Thematic Analysis on Occupational Stress in Staff in an Acute Paediatric Teaching Hospital in Ireland

Lessons From a Crisis: A Thematic Analysis on Occupational Stress in Staff in an Acute Paediatric Teaching Hospital in Ireland

Delirium care in hospitals in Ireland on World Delirium Awareness Day 2023

BackgroundAcute, transient, but sometimes persistent, delirium is characterized by a sharp disruption in attention, consciousness, and cognitive function, and can be caused by many medications and disorders. Delirium occurrence and negative consequences, such as falls and functional decline, can be decreased with multifactorial prevention and timely detection.AimsTo describe current clinical practice in relation to the prevention, assessment, and management of delirium in Irish hospitals; awareness-raising and educational activities; and barriers to good practice.MethodsOn World Delirium Awareness Day (15th March 2023), a global survey was conducted of delirium prevalence and care. A senior clinical staff member on each participating ward reported on delirium prevalence at 8AM and 8PM, and on usual ward practice; this data was entered into an online survey by a data collector (typically a clinician from the site, visiting several wards to record data). This study reports data from Irish hospitals.ResultsIn total, 132 wards from 15 hospitals across Ireland participated. Almost 60% of wards used ‘personal judgment’ for delirium assessment. Having at least one delirium training session in the preceding year was associated with greater use of a formal assessment tool (60.3% versus 18.8%; p < 0.001). Wards reported staff training/education as the main priority to improve care, but 72.7% of wards identified insufficient time to train staff as a key barrier.ConclusionsClinical practice related to delirium care requires improvement. Awareness raising and staff training require more focus and time in busy clinical settings.

A review of minimal access surgery provision and training within the United Kingdom

When combined with healthcare pressures, the exponential growth of robotic-assisted surgery (RAS) has impacted UK-based training outcomes, including the learning curve to competency. Aim: To ascertain the current provision of RAS and investigate differences in access to minimal access surgical (MAS) facilities and training across the UK. A two-armed electronic survey was conducted. The first arm questioned clinical leads regarding robotic practice and future training provisions. The second investigated trainee and trainers’ perceptions of MAS training and facilities. 64% (52/81) of responding trusts utilise a robotic system. The majority (68% [55/81]) have plans to expand or acquire a system within 3 years. 171 responses from 112 UK and Republic of Ireland hospitals were collected for Arm 2. Laparoscopic categories queried whether trainees had access to a formal curriculum, training days and sim-boxes. Most consultants (51.9%) and trainees (51.6%) reported that there was no formal local training curriculum for robotic surgery. Combined responses demonstrated 42.1% (n = 195/463) said “yes”, 39.5% (n = 183) “no” and 18.4% (n = 85) “don’t know”. For combined robotic categories (simulation, training days and operative lists) 28.3% (n = 134/473) responded “yes”, 51.6% (n = 244) said “no” and 20.1% (n = 95) said “don’t know”. This study provides insight into the current provision of robotic-assisted surgery at UK trusts and highlights the need to facilitate regular clinical training and equitable access to MAS simulation within a formal curriculum. This may aid regulation of training in parallel with the expansion of robotic practice and avoid a significant skill acquisition gap and risks to patient safety.

AB103. SOH24AB_219. iNEWS V2 escalation policy: a prospective observational study in single tertiary hospital in Ireland

AB103. SOH24AB_219. iNEWS V2 escalation policy: a prospective observational study in single tertiary hospital in Ireland

AB015. SOH24AB_138. A clinical audit on the pre- and post-operative length of stay for patients presenting with obstructing renal or ureteric calculus in a level four university teaching hospital in Ireland

AB015. SOH24AB_138. A clinical audit on the pre- and post-operative length of stay for patients presenting with obstructing renal or ureteric calculus in a level four university teaching hospital in Ireland