Hospital In Northern Ireland Research Articles

Discovering an unknown risk. The unnoticed, potientially life-threatening risk to people with an inherited cardaic arrhythmia during the non-cardiac perioperative period.

Abstract Background Patient safety is a global goal. Known risks to patient safety are a challenge however, that challenge is significantly increased when a risk is unknown but exists. It is estimated that 18 million major surgeries in Europe are non-cardiac surgical procedures. Preventable adverse events remain a challenge within healthcare systems worldwide. Potentially life-threatening conditions such as inherited cardiac arrhythmias (ICA) can be triggered by a number of factors during the perioperative phase. Healthcare professionals’ lack of knowledge, awareness or confidence about risks associated with ICAs during non-cardiac surgical procedures may have an impact on patient safety and quality of care for people with an ICA. Purpose To determine the knowledge and experience of ICA by healthcare professionals, their views towards and confidence in caring for a person with an ICA in a surgical environment. Method A multiple method study using a twenty-four-item questionnaire was distributed to registered nurses and midwives, surgeons and anaesthetists within surgical areas of seventeen hospitals in the Republic of Ireland and Northern Ireland of which 154 were returned and nine qualitative face to face interviews with registered nurses, midwives, and anaesthetists within surgical areas of one hospital in the Republic of Ireland and one hospital in Northern Ireland. Results Triangulation and convergence of data found a lack of knowledge in relation to inherited cardiac arrhythmias the study focused on, Long QT syndrome, Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) and Brugada syndrome. Within this, it was reported that 88.4% of participants were not aware of the drugs to avoid lists. Of those who were aware, 11.6%, no surgeon reported being aware of the drugs to avoid lists. It was also reported that participants had no confidence to care for people with an ICA in surgical settings. Years since graduation did not equate to an increase in confidence to care for these conditions. Participants reported reliance on the anaesthetist to be knowledgeable, manage care or take the lead should an adverse event occur. However, only seven of the nineteen anaesthetists who took part were aware of the drugs to avoid lists for ICA. Conclusions This study has found a lack of knowledge and confidence relating to inherited cardiac arrhythmias in surgical settings. It also highlighted that anaesthetists are seen as the professional to go to, however they may be unaware of this. Many surgeries take place globally which have the potential to induce an adverse event in people with an ICA that may result in death. This study has found an unknown blind spot which is a serious patient safety issue and a hazardous medical risk factor.

ThP5.5 - Outcomes Of Laparoscopic Common Bile Duct Exploration And Laparoscopic Cholecystectomy; A Single Centre Review From A District General Hospital In Northern Ireland

Abstract Aim Laparoscopic cholecystectomy with laparoscopic common bile duct exploration is a one-stage therapeutic option for patients presenting with choledocholithiasis. This is a review of outcomes for patients who underwent this procedure in a district general hospital setting in Northern Ireland over a two-year period. Method This is a retrospective review of prospectively collected data concerning all patients who underwent laparoscopic cholecystectomy and laparoscopic common bile duct exploration between October 2021 and October 2023. Data were reviewed to include pre-operative liver function, pre-operative imaging, rate of conversion to open procedure, length of stay, and readmission rate due to complications. Results 106 patients were included in the review. The average length of stay was 2.7 days (with a median of 1 day) and readmission rate was 7.5%. 87.7% of patients had deranged liver function tests on the morning of surgery, and 100% had proven choledocholithiasis on cross-sectional imaging prior to proceeding to theatre. Only two patients required conversion to open cholecystectomy. No patients developed postoperative pancreatitis. The complication rate was 11.3%, with most complications being of Clavien-Dindo Grade I or II. Conclusions Laparoscopic common bile duct exploration at the time of laparoscopic cholecystectomy represents a safe and effective method for management of choledocholithiasis. It can be considered as an alternative to endoscopic retrograde cholangiopancreatography as a therapeutic option in an appropriately selected patient group.

540 Outcomes of Laparoscopic Common Bile Duct Exploration and Laparoscopic Cholecystectomy; a Single Centre Review from a District General Hospital in Northern Ireland

Abstract Aim Laparoscopic cholecystectomy and common bile duct exploration is a one-stage therapeutic option for patients presenting with choledocholithiasis. This is a review of outcomes for patients who underwent this procedure in a district general hospital setting in Northern Ireland over a two-year period. Method This is a retrospective review of prospectively collected data concerning all patients who underwent laparoscopic cholecystectomy and common bile duct exploration between October 2021 and October 2023. Data were reviewed to include pre-operative liver function, pre-operative imaging, rate of conversion to open procedure, length of stay, and readmission rate due to complications. Results 106 patients were included in the review. The average length of stay was 2.7 days (with a median of 1 day). 87.7% of patients had deranged liver function tests on the morning of surgery, and 100% had proven choledocholithiasis on cross-sectional imaging prior to proceeding to theatre. Only two patients required conversion to open cholecystectomy. No patients developed post-operative pancreatitis. The complication rate was 11.3%, with most complications being of Clavien-Dindo Grade I or II. The readmission rate was 7.5%. Conclusions Common bile duct exploration at the time of laparoscopic cholecystectomy represents a safe and effective method for management of choledocholithiasis. It can be considered as an alternative to endoscopic retrograde cholangiopancreatography as a therapeutic option in an appropriately selected patient group.

The use of parent-completed questionnaires to investigate developmental outcomes in large populations of children exposed to antiseizure medications in pregnancy.

This study was undertaken to assess the utility of the Ages and Stages Questionnaire-3rd Edition (ASQ-3) and the Vineland Adaptive Behavior Scales-2nd Edition (VABS-II) as neurodevelopmental screening tools for infants exposed to antiseizure medications in utero, and to examine their suitability for use in large-population signal generation initiatives. Participants were women with epilepsy who were recruited from 21 hospitals in England and Northern Ireland during pregnancy between 2014 and 2016. Offspring were assessed at 24 months old using the Bayley Scales of Infant Development-3rd Edition (BSID-III), the VABS-II, and the ASQ-3 (n = 223). The sensitivity and specificity of the ASQ-3 and VABS-II to identify developmental delay at 24 months were examined, using the BSID-III to define cases. The ASQ-3 identified 65 children (29.1%) as at risk of developmental delay at 24 months using standard referral criteria. Using a categorical approach and standard referral criteria to identify delay in the ASQ-3 and BSID-III at 24 months, the ASQ-3 showed excellent sensitivity (90.9%) and moderate specificity (74.1%). Utilizing different cut-points resulted in improved properties and may be preferred in certain contexts. The VABS-II exhibited the strongest psychometric properties when borderline impairment (>1 SD below the mean) was compared to BSID-III referral data (sensitivity = 100.0%, specificity = 96.6%). Both the ASQ-3 and VABS-II have good psychometric properties in a sample of children exposed to antiseizure medications when the purpose is the identification of at-risk groups. These findings identify the ASQ-3 as a measure that could be used effectively as part of a tiered surveillance system for teratogenic exposure by identifying a subset of individuals for more detailed investigations. Although the VABS-II has excellent psychometric properties, it is more labor-intensive for both the research team and participants and is available in fewer languages than the ASQ-3.

A valuation study to identify the determinants of the demand for time spent outdoors among users of hospital facilities, their willingness-to-pay for green infrastructure improvements, and the implications for planning

ABSTRACT Green infrastructure has been promoted as an urban planning tool for the achievement of health and environmental policy objectives. The capacity of economic valuation methods to estimate monetary benefit values for intangible goods, such as mental health and wellbeing, renders them useful in justifying green infrastructure interventions and guiding their implementation. In this case study we used stated preference methods to elicit cross-sectional data on the preferences of staff (n=118), visitors (n=88), and inpatients (n=35) of Musgrave Park Hospital in Northern Ireland, for improvements in the hospital’s outdoor grounds. To our knowledge, this is the first paper to use the contingent behavior method to examine the demand for time spent on the improved outdoor grounds of a hospital and the first to use the contingent valuation method to obtain the respective willingness-to-pay values. The results show that the three hospital user groups differed in their preferred types of green infrastructure and their motivations for using the outdoor grounds, an important input for planning the transformation of the outdoors. Other findings suggest that to maximize health and well-being benefits, complementary measures to address the issues of sedentary lifestyles and inadequate use of the outdoors as a stress-coping mechanism are needed.

Antimicrobial prescribing in a secondary care setting during the COVID-19 pandemic.

Increased antimicrobial resistance patterns lead to limited options for antimicrobial agents, affecting patient health and increasing hospital costs. To investigate the antimicrobial prescribing patterns at two district hospitals in Northern Ireland before and during the COVID-19 pandemic. A mixed prospective-retrospective study was designed to compare pre- and during pandemic antimicrobial prescribing data in both hospitals using a Global Point Prevalence Survey. Of the 591 patients surveyed in both hospitals, 43.8% were treated with 402 antimicrobials. A total of 82.8% of antimicrobial prescriptions were for empirical treatment. No significant difference existed in numbers of patients treated or antimicrobials used before and during the pandemic. There was a slight decrease of 3.3% in the compliance rate with hospital antimicrobial guidelines during the pandemic when compared with the pre-pandemic year of 2019, when it was 69.5%. Treatment based on patients' biomarker data also slightly decreased from 83.5% pre-pandemic (2019) to 81.5% during the pandemic (2021). There was no overall significant impact of the pandemic on the antimicrobial prescribing patterns in either hospital when compared with the pre-pandemic findings. The antimicrobial stewardship programmes would appear to have played an important role in controlling antimicrobial consumption during the pandemic.

Frailty is a better predictor than age for shockable rhythm and survival in Out-of-Hospital cardiac arrest in over 16-year-olds

ObjectiveTo determine if the Clinical Frailty Scale (CFS) predicts out-of-hospital cardiac arrest (OHCA) outcomes better than age?Design: The analysed data was collected as part of a larger study run by NCEPOD on hospital admissions for OHCA in 2018. Study selection was OHCA in over 16-year-olds with restoration of spontaneous circulation (ROSC) for >20 mins and who were admitted to hospital, or who died in the emergency department. Patients from hospitals in England, Wales and Northern Ireland were identified using standard coding for cardiac arrest. CFS, age and gender were examined against two binary outcomes (non-shockable rhythm and survival) Results304 patients with a known CFS, known original rhythm, and known outcome were included. Younger patients had lower CFSs, as a continuous variable (Pearson correlation coefficient 0.44, p-value < 0.001) and in CFS groupings of 1–3, 4–6, 7–9 (p-value < 0.001). CFSs were higher (p-values < 0.001) for both non-shockable rhythm and death (median CFS was 4 for death and 2 for survivors). Logistic regression analysis of continuous scale CFS showed the association with non-shockable rhythm remained when adjusted for age and sex (odds ratio [95% CI]; age adjustment 1.46 [1.28, 1.68] p-value < 0.001) and remained for survival when adjusted for age alone (odds ratio [95% CI]; 1.60 [1.36, 1.88] p-value < 0.001) and when adjusted for age, sex and initial rhythm combined (1.45 [1.21, 1.73] p-value < 0.001). 3.2% of patients had resuscitation against their advanced-care-directives. 12.9% (23/178) of hospitals had electronic systems which shared advance-care-directives with ambulance services and primary care. ConclusionA higher CFS is a prognostic indicator in adult OHCA independent of age. Frail individuals have a lower likelihood of a shockable rhythm and poorer survival. Sensitive sharing of this information with patients when discussing advance-care-directives may enhance shared decision-making.

107 OPEN to Change: Can District General Hospitals Deal with Open Fractures Too?

Abstract Introduction Fractures compromising soft tissues puts patients at risk of significant morbidity, therefore require timely multidisciplinary management. The British Orthopaedic Association Standard for Trauma (BOAST) Guidelines, updated December 2017, state “Patients with open fractures of long bones, hind foot or midfoot should be taken directly or transferred to a specialist centre that can provide Orthoplastic care.” Northern Ireland’s population is estimated at 1.8 million, within this there are between 370 and 500 cases of major trauma each year. Method This review looks at patients presenting to Craigavon Area Hospital in Northern Ireland, between October 2021 to October 2022, with open fractures. Results Over the study period, 41 Open fractures presented, 12 meeting criteria for transfer to a major trauma centre with orthopastic’s present as per BOAST Guidelines point 1. However, 11 patients were managed in Craigavon Area Hospital and 1 patient required transfer to a site with plastics available. Conclusions Can we learn from this same subgroup of patients? There is an ever-growing demand to major trauma centres in Northern Ireland some of the burden on which can be dealt with by DGH’s. This data should help contribute to any future updates of BOAST’s guidelines.

Suspected cancer (red flag) referrals: A review of our experience in Northern Ireland

AbstractAimHead and neck cancer continues to represent a significant source of morbidity and mortality for patients. Alongside prevention, early recognition is key to improving patient outcomes. We aim to present our experience of suspected cancer referrals to the oral surgery/oral medicine units within a dental hospital in Northern Ireland in terms of patient demographic, referral quality, and referral outcome.Materials and MethodsPatients who were referred to the oral surgery or oral medicine departments within the Queen's University Belfast Dental hospital between January and September 2018, and placed on the suspected cancer (Red Flag) pathway, had their records reviewed. Data was extracted by 2 calibrated dentists using predetermined data extraction forms.ResultsOverall, 377 patient referrals were identified with the majority coming from dentists (GDPs) and general practitioners (GMPs). GMP referrals were commonly via the e‐referral system (97%), and GDP via post or email (97%). E‐referrals underwent triage faster than other referral methods. Of the original referrals, 62% remained on the red flag pathway following consultant triage, and all were allocated appointments within 2 weeks. Ulcers, swellings, and white patches were the most referred lesions with just 5.5% of referrals including clinical photographs. Overall, positive predictive value (PPV) was 5.3% (8% for GDPs and 3% for GMPs).ConclusionOur department successfully met the 2‐week target in all cases. PPV does however remain low, but within recognised guidance limits, and could potentially be improved by further education of referrers and/or inclusion of a clinical photo at the time of referral.

Pregnancy loss following miscarriage and termination of pregnancy for medical reasons during the COVID-19 pandemic: a thematic analysis of women’s experiences of healthcare on the island of Ireland

BackgroundLosing a baby during pregnancy can be a devastating experience for expectant parents. Many report dedicated, compassionate healthcare provision as a facilitator of positive mental health outcomes, however, healthcare services have been severely impacted during the COVID-19 pandemic.AimTo explore women’s experiences of healthcare service provision for miscarriage and termination of pregnancy for medical reasons (TFMR) on the island of Ireland during the COVID-19 pandemic.MethodsFindings combine data from elements of two separate studies. Study 1 used a mixed methods approach with women who experienced miscarriage and attended a hospital in Northern Ireland. Study 2 was qualitative and examined experiences of TFMR in Northern Ireland and Ireland. Data analysed for this paper includes open-ended responses from 145 women to one survey question from Study 1, and semi-structured interview data with 12 women from Study 2. Data were analysed separately using Thematic Analysis and combined for presentation in this paper.ResultsCombined analysis of results indicated three themes, (1) Lonely and anxiety-provoking experiences; (2) Waiting for inadequate healthcare; and (3) The comfort of compassionate healthcare professionals.ConclusionsWomen’s experiences of healthcare provision were negatively impacted by COVID-19, with the exclusion of their partner in hospital, and delayed services highlighted as particularly distressing. Limited in-person interactions with health professionals appeared to compound difficulties. The lived experience of service users will be helpful in developing policies, guidelines, and training that balance both the need to minimise the risk of infection spread, with the emotional, psychological, and physical needs and wishes of parents. Further research is needed to explore the long-term impact of pregnancy loss during a pandemic on both parents and health professionals delivering care.

Severe mental illness and ophthalmic health: A linked administrative data study.

While evidence has emerged highlighting the potential benefits of the eye as a window to the central nervous system, research on severe mental illness (SMI) and eye health is rare. We examine the association of SMI with a range of ophthalmic health outcomes, and whether any relationship is modified by age. We used linked administrative data from general practitioner (GP), hospital and ophthalmic records to examine receipt of any Health and Social Care (HSC) eye-test; and (based on eligibility recorded for a sight test) any glaucoma, any diabetes, and any blindness among the Northern Ireland (NI) hospital population between January 2015 and November 2019 (N = 798,564). When compared with non-SMI patients, those with SMI recorded a higher prevalence of having had a sight test, diabetes, and blindness. In fully adjusted logistic regression models, higher likelihood of an eye-test and diabetes (OR = 1.71: 95%CI = 1.63, 1.79 and OR = 1.29: 1.19, 1.40 respectively); and lower likelihood of glaucoma remained (OR = 0.69: 0.53, 0.90). Amongst persons with SMI there was evidence that the likelihood of having had an eye-test was lower in the older age-groups. Our study provides new evidence on ophthalmic health inequalities associated with SMI. While the study has immediate relevance to its NI context, we believe it is generalizable to wider UK health concerns. We emphasize the need for more research of this type, using large linkable electronic administrative databases to further our understanding of both health inequalities associated with SMI and poor eye health, and health outcomes in general.

Adherence to metformin in adults with type 2 diabetes: a combined method approach

BackgroundMedication adherence, one of the most important aspects in the process of optimal medicines use, is unfortunately still a major challenge in modern healthcare, and further research is required into how adherence can be assessed and optimised. The aim of this study was to use a combined method approach of self-report and dried blood spot (DBS) sampling coupled with population pharmacokinetic (PopPK) modelling, to assess adherence to metformin in adult patients with type 2 diabetes. Further aims were to assess metformin exposure levels in patients, determine factors associated with non-adherence with prescribed metformin, and to explore the relationship between adherence and therapeutic outcomes.MethodsA combined method approach was used to evaluate metformin adherence in patients with type 2 diabetes who had been prescribed metformin for a minimum period of 6 months. Patients were recruited from consultant-led diabetic outpatient clinics at three hospitals in Northern Ireland, UK. Data collection involved self-reported questionnaires [Medication Adherence Report Scale (MARS), Beliefs about Medicines Questionnaire and Centre for Epidemiologic Studies Depression Scale], direct measurement of metformin concentration in DBS samples, and researcher-led patient interviews. The DBS sampling approach was coupled with population pharmacokinetic (PopPK) modelling, which took account of patient characteristics, metformin dosage and type of formulation prescribed (immediate or sustained release).ResultsThe proportion of patients considered to be adherent to their prescribed metformin, derived from self-reported MARS scores and metformin concentration in DBS samples, was 61.2% (74 out of 121 patients). The majority (n = 103, 85.1%) of recruited patients had metformin exposure levels that fell within the therapeutic range. However, 17 patients (14.1%) had low exposure to metformin and one patient (0.8%) had undetectable metformin level in their blood sample (non-exposure). Metformin self-administration and use of a purchased adherence pill box significantly increased the probability of a patient being classified as adherent based on logistic regression analysis. Both HbA1c and random glucose levels (representing poor glycaemic control) in the present research were, however, not statistically linked to non-adherence to metformin (P > 0.05).ConclusionsA significant proportion of participating patients were not fully adherent with their therapy. DBS sampling together with the use of a published PopPK model was a useful, novel, direct, objective approach to estimate levels of adherence in adult patients with type 2 diabetes (61.2%).

Biomarkers to assess the risk of bladder cancer in patients presenting with haematuria are gender-specific.

IntroductionHaematuria is a common red flag symptom of urinary tract cancer. Bladder cancer (BC) is the most common cancer to present with haematuria. Women presenting with haematuria are often underdiagnosed. Currently, no gender-specific tests are utilized in clinical practice. Considerable healthcare resources are needed to investigate causes of haematuria and this study was set up to help identify markers of BC. The aim of the study was to define biomarker algorithms in haematuria patients using an expanded panel of biomarkers to diagnose BC and investigate if the algorithms are gender-specific.Materials and MethodsA total of n=675 patients with a history of haematuria were recruited from Northern Ireland hospitals. Patients were collected on a 2:1 ratio, non-BC (control) n=474: BC n=201. A detailed clinical history, urine and blood samples were collected. Biomarkers, known to be involved in the pathobiology underlying bladder carcinogenesis were investigated. Biomarkers differentially expressed between groups were investigated using Wilcoxon rank sum and linear regression.ResultsBiomarkers were gender specific. Two biomarker-algorithms were identified to triage haematuria patients; male – u_NSE, s_PAI-1/tPA, u_midkine, u_NGAL, u_MMP-9/TIMP-1 and s_prolactin (u=urine; s=serum); sensitivity 71.8%, specificity 72.8%; AUROC 0.795; and female urine biomarkers - IL-12p70, IL-13, midkine and clusterin; sensitivity 83.7%, specificity 79.7%; AUROC 0.865. Addition of the clinical variable infection to both algorithms increased both AUROC to 0.822 (DeLong p=0.014) and to 0.923 (DeLong p=0.004) for males and females, respectively. Combining clinical risk factors with biomarker algorithms would enable application of the algorithms to triage haematuria patients.ConclusionUsing gender-specific biomarker algorithms in combination with clinical risks that are associated with BC would allow clinicians to better manage haematuria patients and potentially reduce underdiagnosis in females. In this study, we demonstrate, for the first time, that blood and urine biomarkers are gender-specific when assessing risk of BC in patients who present with blood in their urine. Combining biomarker data with clinical factors could improve triage when referring patients for further investigations.

Mind the gap: an administrative data analysis of dental treatment outcomes and severe mental illness.

ObjectivesOral health of people with severe mental illness (SMI) remains an important public health issue with some evidence pointing suboptimal dental health outcomes. We test the hypotheses that individuals with SMI have lower contact with dental services and higher levels of fillings and extractions. We also examine effect modification by age. ApproachWe used linked administrative data from general practitioner (GP) records, hospital admissions data and dental payment system data to examine dental service use and treatments (extractions, fillings, crowns and x-rays) among the Northern Ireland hospital population between January 2015 and November 2019 (N=798,564). Logistic regression examined the association of SMI with dental service use and treatments, controlling for socio-demographic characteristics. In a further series of models, the interaction of SMI and age-group was examined. ResultsAn estimated 1.2% (9,656) recorded an SMI diagnosis from hospital records at some point during follow-up. Over two-thirds (67.2%) of the non-SMI hospital population received any dental treatment compared with 62.2% of persons SMI-diagnosed. After adjusting for available socio-demographic characteristics, analysis indicated lower levels of dental service use (OR=0.80, 95% CI=0.77, 0.84), including lower likelihood of fillings (OR=0.81, 0.77, 0.84) and x-rays (OR=0.77, 0.74, 0.81), but higher levels of extractions (OR=1.23, 1.18, 1.29) among patients with SMI. We also found effect modification by age-group: while older age was generally associated with higher likelihood of extractions and crowns, interaction analysis points to lower likelihood of all four dental treatments among older individuals with SMI. ConclusionsOur findings of lower engagement with dental services, lower levels of remedial treatments and higher levels of tooth loss raise concerns about availability, access, and promotion of routine dental care for people with SMI. There is a need for improved understanding of barriers to treatment and development of psychoeducational interventions.

Mind the gap: an administrative data analysis of dental treatment outcomes and severe mental illness

Background Oral health of people with severe mental illness (SMI) remains an important public health issue, despite evidence pointing suboptimal dental health outcomes in this population. Aims We test the hypotheses that individuals with SMI have lower contact with dental services and higher levels of fillings and extractions. We also examine effect modification by age-group. Methods We used linked administrative data from general practitioner (GP), hospital and dental records to examine dental service use and treatments (extractions, fillings, crowns and x-rays) among the Northern Ireland hospital population between January 2015 and November 2019 (N = 798,564). Results After adjusting for available socio-demographic characteristics, analysis indicated lower levels of dental service use (OR = 0.80, 95% CI = 0.77, 0.84), including lower likelihood of fillings (OR = 0.81, 0.77, 0.84) and x-rays (OR = 0.77, 0.74, 0.81), but higher levels of extractions (OR = 1.23, 1.18, 1.29) among patients with SMI. We also found effect modification by age-group, with older individuals with SMI less likely to have each of the four dental treatments. Conclusions We suggest that in the general area of physical healthcare for people with SMI, oral healthcare is neglected. There is a need for improved understanding of the barriers to routine care and treatment, and development of psychoeducational interventions.

The Impact of Drug Burden Index on Unplanned Hospital Readmission and Length of Hospital Stay

Background: The Drug Burden Index (DBI) is a pharmacotherapy risk assessment tool explored to evaluate its association with unplanned hospital-related outcomes. Objective: To evaluate the DBI association with unplanned hospital readmissions, develop a prediction model for unplanned readmissions. To investigate DBI association with length of hospital stay (LOS). Setting: Unplanned readmission data were collected for 1000 adult hospitalized patients at Antrim Area Hospital in Northern Ireland. Method: The study was designed as a retrospective analysis. Logistic regression models were developed to determine the prediction power. Discriminative ability testing was carried out using the Receiver Operating Characteristic (ROC) curve. Youden's index formula was used to detect the cut-off points. Analysis of covariance (ANCOVA) was performed to determine whether LOS differed based on the DBI score. Finally, negative binomial regression was used to predict LOS based on DBI. Results: Of the 1000 patient records, 43% were females, and a total of 885 (88.5%) were exposed to sedative and anticholinergic medications (DBI&gt;0). Readmission rates at 7, 14, 30 and 90 days were 5.4%, 9.0%, 15.0% and 28.8% respectively. The odds ratio (OR) of readmission within seven days for patients with DBI&gt;1 was 3.42 times higher than those who had their DBI=0 (OR= 3.42, 95% CI: 1.6–7.3; P= 0.001). The DBI category significantly predicts 7-day readmission (P=0.002), the area under the curve for the ROC curve was 0.65 (95% CI: 0.58 - 0.71; P&lt;0.001). For 14-day readmissions, patients with a DBI &gt;1, compared with DBI=0, had a reported higher Odds Ratio (OR = 2.19, 95% CI: 1.1– 4.4; P= 0.025). However, the DBI category prediction power for 14-day readmission was not significant (P=0.069). DBI failed to show an association with 30- and 90-day readmissions. The adjusted estimated marginal difference for LOS of patients with DBI&gt;1 vs. DBI=0 was 2.7 (95%CI: 0.89 – 4.5; P=0.003). Conclusion: DBI was a statistically significant tool to predict 7-days unplanned readmission. DBI was not a statistically significant predictor for readmission over longer periods. Higher DBI was associated with a longer LOS. Impact on Practice Statements: Readmission within seven days of a patient's discharge can be predicted by the DBI, and a longer hospital stay was also associated with higher DBI. Accordingly, the hospital teams can consider reporting DBI scores and performing tailored discharge plans for patients who are at risk for seven days of unplanned readmission.

The Development of an Enhanced Palliative Care Pharmacy Service during the Initial COVID-19 Surge.

The Northern Health and Social Care Trust developed an enhanced palliative care pharmacy service for acute inpatients within a large hospital in Northern Ireland during the initial COVID-19 surge. By training additional staff, there was an opportunity to increase service provision, utilising palliative care pharmacy skills to undertake activities such as the symptom management of patients, appropriate management of medicines, improved access to medicines, advice for other healthcare professionals, and supporting discharge from the hospital. The data collected showed a mean of 6.8 interventions per patient, and that, irrespective of the demand resulting from the COVID-19 pandemic, the palliative care pharmacy team had a role in improving the quality of care for palliative and end-of-life patients. Subsequent data analysis also demonstrated associated cost saving and the potential for the palliative care pharmacy team to reduce the length of stay at the hospital.

ANTICIPATING THE PATIENT EMERGENCY DATA IN HOSPITAL USING MACHINE LEARNING ALGORITHM

Crowding within emergency departments (EDs) can have significant negative consequences for cases. EDs thus need to explore the use of innovative styles to ameliorate case inflow and help overcrowding. One implicit system is the use of data mining using machine literacy ways to prognosticate ED admissions. This paper uses routinely collected executive data (120 600 records) from two major acute hospitals in Northern Ireland to compare differing machine literacy algorithms in prognosticating the threat of admission from the ED. We use three algorithms to make the prophetic models 1) logistic retrogression 2) decision trees; and 3) grade boosted machines (GBM). The GBM performed better (delicacy80.31, AUC-ROC 0.859) than the decision tree (delicacy80.06, AUC-ROC 0.824) and the logistic retrogression model (delicacy79.94, AUCROC 0.849). Drawing on logistic retrogression, we identify several factors related to sanitarium admissions, including sanitarium point, age, appearance mode, triage order, care group, former admission in the once month, and former admission in the once time. This paper highlights the implicit mileage of three common machine learning algorithms in prognosticating patient admissions. Practical perpetration of the models developed in this paper in decision support tools would give a shot of prognosticate admissions from the ED at a given time, allowing for advance resource planning and the avoidance backups in case inflow, as well as comparison of prognosticate and factual admission rates. When interpretability is a crucial consideration, EDs should consider espousing logistic retrogression models, although GBM’s will be useful where delicacy is consummate.

Acute Pancreatitis During COVID-19 Pandemic: An Overview of Patient Demographics, Disease Severity, Management and Outcomes in an Acute District Hospital in Northern Ireland.

BackgroundAcute pancreatitis (AP) is a common disease requiring admissions under surgical and critical care units. The two most common causes are alcohol and gallstones. Coronavirus disease 2019 (COVID-19) pandemic had a significant impact on service delivery and patient management throughout all surgical specialties. In this study, the primary aim was to ascertain the incidence of COVID-19 in acute pancreatitis patients. Secondary objectives were to study aetiology, demographics, severity, 30-day mortality, outcomes and management of acute pancreatitis patients from 1st March, 2020 till 31st August, 2020.MethodsA retrospective observational review of all patients admitted under the General Surgical team was performed. Information regarding demographics, severity of AP (using Glasgow score, Atlanta classification and CT severity index score), ICU admission and organ support, treatment modalities and follow-up data for outcomes was collected based on data collection tool used by COVID-PAN study and results were compared to outcomes results of COVID-PAN study.ResultsForty-three (43) patients were admitted with AP. Only one patient (2.3%) was diagnosed with COVID-19 at the time of pancreatitis. Gallstones were noted to be the most common cause of AP in our population. Mortality was 7% (3 patients). Five patients (11%) needed ITU admission due to organ dysfunction. Three patients (7%) developed ARDS.ConclusionThe overall incidence of COVID-19 in pancreatitis in our population of the study was low. The incidence of COVID-19 during the first wave in Derry/Londonderry area was low and this may explain why the incidence was low in our study as well. Patients with AP in our target population were mostly elderly, one in five had moderate to severe or severe pancreatitis and in 16.3% the aetiology could not be identified. As observed in other centres globally, urgent cholecystectomy for gallstone pancreatitis faced significant delays with no patients being offered index cholecystectomy and only 4 out of 19 patients having undergone interval cholecystectomy within six months of index admission for gallstone pancreatitis in our centre.

Abstract 28 - Successful green pathways for elective urology surgery during the COVID-19 pandemic in an acute NHS hospital in Northern Ireland

Abstract 28 - Successful green pathways for elective urology surgery during the COVID-19 pandemic in an acute NHS hospital in Northern Ireland