Hospital Inpatient Enquiry Research Articles

Perinatal deaths in twin and singleton infants in Ireland: A comparison of characteristics and causes.

Twin pregnancies are associated with significantly higher perinatal mortality (PM) rates compared to singletons, primarily due to complications like fetal growth restriction, preterm birth, and congenital anomalies. This study aimed to compare the characteristics associated with PM in twin pregnancies and compare maternal and obstetric factors and cause of death among twins and singletons in the Republic of Ireland. Data spanning 2011 to 2022 from the National Perinatal Epidemiology Centre's annual perinatal mortality clinical audit included 4494 perinatal deaths. Maternal characteristics, antenatal care factors and cause of death were analysed with relative risk calculated using national Hospital In-Patient Enquiry data. Pearson's chi-squared tests studied the difference between mortality in twins and singletons. Twins accounted for 10.4% of all perinatal deaths, despite representing only 3.6% of total births. The PM rate for twins was 17.3 per 1000 births, 3.1 times higher than for singletons. Early neonatal deaths (ENNDs) were more frequent in twins (54.2%), while stillbirths predominated among singletons (68.6%). Younger maternal age and lower BMI were associated with higher PM risks in twins. A considerable proportion of twin deaths with major congenital anomalies or birth before 28weeks gestation occurred in non-tertiary hospitals, suggesting limitations in referral pathways to centres with appropriate neonatal expertise. Twin pregnancies pose a higher risk of perinatal mortality, particularly among younger mothers and preterm births. The findings highlight the need for updated guidelines that prioritise early risk assessment, targeted interventions, and improved referral systems.

Enhancing Delirium Recognition: Assessing The Impact Of Educational Interventions In A Model Three Hospital - A Retrospective Analysis

Abstract Background Delirium is a common medical emergency which is well-known to be associated with adverse outcomes but often remains under-recognised in the acute care setting. In recent years, efforts have been made by our gerontology department to increase awareness of the importance of recognising delirium as a medical condition. Initiatives carried out included the roll-out of education sessions at ward level, medical and nursing grand rounds. Utilising HIPE (Hospital Inpatient Enquiry) data, we assessed whether such interventions have translated into increased recognition of delirium in hospital inpatients. Methods We collated data from the HIPE department in our hospital. HIPE assessed all hospital inpatient medical charts for patients that were discharged each year to assess whether delirium was recorded as a diagnosis in such patients. The data for each discharge year spanning from 2018 to 2022 inclusively was compared. We assessed the number of patients discharged during those years that had a diagnosis of delirium recorded in their chart. Additionally, in conjunction with the frailty team, we reviewed all formal interventions made in our hospital since 2018 to promote awareness around delirium. Results A year-on-year increase in the number of cases of chart-recorded delirium among hospital inpatients between 2018 and 2022 was observed. In 2018, there were 308 diagnoses of delirium made in patients being discharged from hospital that year. This was followed by 342 in 2019, 424 in 2020, 501 in 2021 and 609 in 2022. There were nine different initiatives identified to have been carried out by the gerontology team to increase education around delirium. Conclusion Interventions made have shown to increase the recognition and diagnoses of delirium. With diagnoses increasing by nearly 98% over a five-year period, this shows that interventions to improve awareness of delirium can have significant impact. Recognising delirium is the first step to improving outcomes for patients.

Impact of a Stroke Physician-Provided Loop Recorder Implant Service in a Model 3 Hospital Investigating Embolic Stroke of Undetermined Source:

Abstract Background When Embolic Stroke of Undetermined Source (ESUS) is investigated with an Implanted Loop Recorder (ILR), Atrial Fibrillation (AF) may be detected in about 25%. In Ireland this is usually undertaken by a cardiology service. Non-traditional implanters are now well accepted, though few stroke physicians perform this service. Understanding the expected numbers and workload will allow service planning. Methods The study is a prospectively cohort at a model 3 institution. A stroke physician and CNS-provided implant service was initiated in 2017. The Irish National Audit of Stroke and Hospital Inpatient Enquiry was used estimate the numbers of infarcts. The hospital patient management system was used to evaluate the follow-up provided per case. Consultant time was calculated at 45, 30, 30 and 20 mins per implant, explant, in-person review and tele review respectively. CNS time was calculated at 60 and 45 mins per implant and explant. Descriptive statistics were used. Results Between March 2017 and February 2024, a total of 63 ILR (Reveal LINQ, Medtronic) were implanted by the team, of which 58 were for ESUS; mean age at implant 66.4 years, 39.6% female. Implants as a proportion of the total infarcts in the years 2017-2023 was 6.51%; range from 3.1-9.9%. Excluding the disrupted Covid years and 1st year the average was 8.8%. Of the implants, 34 (60.3%) have been explanted to date. The total median (IQR) time per implant was 120 (100-150) mins and 105 (60-105) mins for consultant and CNS respectively [145 and 105 mins respectively for explanted (completed) cases]. AF has been identified in 17 cases to date (29.3% of implants). Conclusion Implementing an ILR service requires about 2hours of consultant time and 1hour 05 mins of CNS time per case. Expected numbers of implants can be estimate at 8-10% of all infarcts, and a considerable proportion will have AF detected.

Cancer And Stroke - An Irish Centre’s Experience Of Emerging Trends Of Co-Diagnosis

Abstract Background Cancer is an increasingly recognised independent risk factor for the development of stroke, with emerging evidence of stroke, in the context of malignancy being its own pathophysiological subtype (Sonbol et al., 2023). Both cancer and stroke risk are associated with increasing age, with stroke mortality in cancer patients significantly higher (Sanossian et al., 2012). Due to the increasingly ageing population in Ireland, the number of those presenting with dual diagnosis is set to increase. We sought to review numbers presenting with stroke and cancer to our stroke service. Methods Patients admitted with confirmed stroke diagnosis were identified through Hospital Inpatient Enquiry (HIPE) data from March 2023 to May 2024. This cohort was then screened for a co-existing oncological diagnosis. The following variables were collected: recency of cancer diagnosis, subtype of stroke, anti-cancer therapy treatment to date, risk factors for developing cardiovascular disease using atherosclerosis cardiovascular disease score (ASCVD) and baseline CRP on admission. Results 71/320 (22%) patients admitted to our service in the defined period were identified as having a co-diagnosis of stroke and cancer (new or historical). Of those 71 patents, 8(11%) had a new or recent (<1 year) cancer diagnosis at stroke presentation and 63 were found to have a historical diagnosis (>1year). Prostate cancer represented the largest proportion of patients followed by lung and skin. 11(15%) were actively on cancer treatment at time of presentation of stroke. For patients actively on treatment, 5/11 had received platinum-based therapies. Average ASCVD risk factor score was 29.7%. Conclusion One in five patients with acute stroke had new or historical diagnosis of cancer in our cohort. A national prospective registry of patients with cancer and stroke could be useful in understanding patterns of stroke in cancer and help plan services and treatments for this specific population.

Efficacy of a Nursing Home Liaison Service In Supporting Early Hospital Discharge For Long-Term Care Facility Residents

Abstract Background Long-term care facility residents (LTCR) are prone to acute illness and hospital admission due to underlying factors including advanced age, chronic comorbidity and increased frailty. A new Nursing Home Liaison (NHL) service (consisting of two advanced practice nurses) commenced recently with the aim of providing early supported discharge for LTCR admitted to hospital. This study aims to describe the efficacy of the NHL service in reducing length of stay (LOS) and readmission rates for LTCR in comparison to data from the year prior to NHL commencement. Methods Hospital In-Patient Enquiry (HIPE) data was retrospectively obtained for the pre-service group (PSG), consisting of all medically admitted LTCR in 2022. This included demographic data, International Classification of Diseases diagnosis, LOS, and discharge outcome. The same prospective data was obtained by chart review for the service group (SG), for LTCR following the initialization of NHL between September 2023 and March 2024. Unpaired t-test and Chi-squared test was used to determine significant difference between the two groups. Results There were 249 LTCR in the PSG and 171 in the SG. The average age (84 vs 81) and dementia diagnosis rate (60% vs 55%) were similar amongst the two groups. The most common reason for admission in both groups was infection (60% vs 40%). The median LOS was significantly lower for the SG as compared to the PSG (8 vs 6 days, p=0.02). The PSG also had higher seven-day (6.4% vs 4.1% p=0.3) and 30-day (14.5% vs 7.6% p=0.03) readmission rates. Conclusion The introduction of a dedicated NHL service for LTCR has resulted in a significant reduction in hospital LOS and readmission rates. By providing enhanced communication through telehealth review and assistance with advanced care planning, the NHL service effectively bridges the gap between acute and community care, resulting in improved patient flow and delivery of person-centred outcomes.

Diagnostic Challenges and Outcomes in Transient Loss of Consciousness: A Retrospective Analysis

Abstract Background Transient loss of consciousness (T-LOC) is a common presenting complaint, posing significant diagnostic challenges. This study explores outcomes for T-LOC. Methods Using the Hospital Inpatient Enquiry System, data on patients with T-LOC were collected at a large academic teaching hospital over six months, including demographics, length of stay (LOS), diagnostic tests, and discharge diagnoses. Results A total of 160 T-LOC patient visits were analysed, divided into three age cohorts: under 65 (n=66), 65-74 (n=38), and over 75 (n=56). Of the 94 patients aged over 65 (58.75% of the sample), mean age was 76.07 years; 47% were female. Diagnostics varied by age, with higher rates of computed tomography of the brain (87.23%) and lying-standing blood pressure (37.23%) in those over 65. Conversely, those over 65 were less likely to receive electrocardiograms (86.17% vs. 96.97%), telemetry (51.06% vs. 59.09%), magnetic resonance imaging of the brain (21.28% vs. 25.76%), transthoracic echocardiograms (14.89% vs. 25.76%), and exercise stress tests (3.19% vs. 10.61%) compared to those under 65. Carotid ultrasound and electroencephalography were infrequently performed across all age groups. Patients aged over 75 were most likely to have a diagnosis (78.57% vs 60.53% in 65-74 and 60.61% in under 65). Orthostatic hypotension was the most common diagnosis 8.51% (8/94) of those over 65. 33.13% (53/160) of patients had no diagnosis documented. LOS increased with age: averaging 6 days (range 1-19) for those under 64, 7.45 days (range 1-36) for those 65-74, and 9.09 days (range 1-64) for those over 75. Older adults were less likely to receive cardiology (19.15%) and neurology consultations (11.70%) compared to those under 65 (27.27% and 36.36%, respectively). Conclusion A considerable number of patients lacked a diagnosis, highlighting the diagnostic complexities of T-LOC. The development of a specialist syncope assessment pathway is underway to improve diagnostics, potentially reducing unnecessary tests and hospital stays.

Examining the COVID-19 impact on cancer surgery in Ireland using three national data sources

BackgroundThe healthcare system in Ireland was profoundly affected by COVID-19. This study aimed to explore the impact of the pandemic on cancer surgery in Ireland, from 2019 to 2022 using three national health data sources. MethodsA repeated cross-sectional study design was used and included: (i) cancer resections from the National Histopathology Quality Improvement (NHQI) Programmes; (ii) cancer surgery from the National Cancer Registry Ireland (NCRI), and (iii) cancer surgery from Hospital Inpatient Enquiry (HIPE) System. Cancer surgery was presented by invasive/in situ and invasive only cancers (NCRI & HIPE), and by four main cancer types (breast, lung, colorectal & melanoma for NCRI & HIPE data only). ResultsThe annual number of cancer resections (NHQI) declined by 4.4% in 2020 but increased by 4% in 2021 compared with 2019. NCRI data indicated invasive/in-situ cancer surgery for the four main cancer types declined by 14% in 2020 and 5.1% in 2021, and by 12.3% and 7.3% for invasive cancer only, compared to 2019. Within HIPE for the same tumour types, invasive/in situ cancer surgery declined by 21.9% in 2020 and 9.9% in 2021 and by 20.8% and 9.6% for invasive cancer only. NHQI and HIPE data indicated an increase in the number of cancer surgeries performed in 2022. ConclusionsCancer surgery declined in the initial pandemic waves suggests mitigation measures for cancer surgery, including utilising private hospitals for public patients, reduced the adverse impact on cancer surgery.

Trends in the surgical management of proximal humerus fractures in Ireland from 2009 to 2022: An increasing usage of reverse shoulder arthroplasty

BackgroundProximal humeral fractures are a common injury accounting for a significant workload across orthopaedic departments. Though often managed non-operatively, surgical management is indicated for a proportion of patients.AimsThe aim of this study is to examine the trends in the management of proximal humeral fractures within Ireland over the past 13 years.MethodsA retrospective review of Irish Hospital In-Patient Enquiry (HIPE) data was performed between January 2009 and December 2022. Information regarding demographics including age and gender, along with procedure type were collated after patients with proximal humerus fractures, were identified using relevant ICD 10 codes.ResultsDemographic details remained stable with females and those within the 55–69 year age bracket accounting for the highest proportion of patients. The mean annual number of procedures performed across the study period was 365 (273–508), with an increase from 288 cases in 2009 to 441 in 2022. Open reduction and internal fixation were the most common procedures accounting for 76.4% of cases. There has been a rising usage of total shoulder arthroplasty for fixation with an increase from < 5 cases in 2016 to 84 in 2022. A decrease in the usage of hemiarthroplasty and closed reduction internal fixation was also observed.ConclusionsThere has been an increasing volume of operatively managed proximal humeral fractures in Ireland, which sustained despite the 2015 publication of the highly publicised PROPHER trial. The increasing utilisation of total shoulder arthroplasty in acute trauma management is notable and necessitates appropriate training for trauma theatre personnel.

Retrospective cross-sectional analysis of concurrent VTE diagnosis in hospitalised socially excluded individuals in Ireland

ObjectiveSocial exclusion (such as that experienced by people who are homeless, incarcerated or use drugs) increases morbidity across a range of diseases but is poorly captured in routine data sets....

The necessity of removal of third molars involved in mandibular fractures: A retrospective study

This retrospective analysis aimed to investigate the necessity of removing the wisdom tooth in cases of angle fractures of the mandible. The study retrieved 595 mandible fractures from January 2006 to December 2021 through the Hospital Inpatient Enquiry System, of which 303 involved a fracture through the angle of the mandible, including the wisdom tooth socket. Of these, 203 (66.9%) underwent open reduction and internal fixation with retention of the third molar. The authors found that only four (2%) patients returned for the removal of plates and the retained third molar during the follow-up period. Therefore, the authors concluded that wisdom teeth removal should remain an exception during open reduction and internal fixation of mandibular angle fractures unless they hinder fracture reduction, pose a potential infection risk, or interfere with occlusal stability.

In-Hospital Hip Fractures in a Large Irish Teaching Hospital: Patient Risk Factors and Outcomes.

In-hospital hip fractures follow falls during unrelated admissions. Little data in the Irish setting is available on this vulnerable subset of hip fracture patients. Our objective is to review the incidence of in-hospital hip fractures, identify risk factors, and evaluate outcomes. This is a retrospective observational review. We collected patient data in St. James' Hospital using the Hospital In-Patient Enquiry database and Electronic Patient Recordsfor in-hospital hip fractures between 10/02/2017 and 22/04/2020. Comorbidity, survival, and discharge destination data were gathered. We identified 40 fractures, representing 11.5% of all hip fractures treated at our center during the study period. The patients were 60-95 years old. Median age was 77 years for males and 86 years for females. Most (72.5%) were identified as fall risks, and 52% were unwitnessed falls. Many had a history of falls (67.5%), dementia (52.5%), or both (42.5%). Delirium was common (42.5%), and 75% had at least one vascular/coagulation disorder. Mortality was 10.25% at 30 days, 23.1% at 90 days, and 51.4% at 12 months. Although 70% were admitted from home, only 10% were discharged back home. 30% were admitted to a nursing home, and 55% were discharged from a nursing home. In-hospital hip fractures accounted for 11.5% of all hip fractures treated at our center, confirming the need for a well-defined hospital protocol. Patients often present with previous falls, dementia, and cardiovascular disease. Outcomes are poor, with 51.4% mortality at 12 months and significant morbidity reflected by a loss of independent living.

175 Navigating the transient ischaemic attack pathway—unveiling the gaps and developing a standard solution

Abstract Background Hyperacute management of a Transient Ischemic Attack (TIA) is necessary to decrease subsequent stroke. We examined our current management of TIA patients to inform a quality improvement initiative to bring our practice in line with the 2023 UK and Ireland Clinical Guidelines for Stroke. Methods We completed a retrospective cohort study of patients who attended our hospital between December 1st 2022 and February 28th 2023. Patients with a primary diagnosis of TIA were identified though the Hospital In-Patient Enquiry (HIPE). Each diagnosis was verified with electronic records review, with exploration of key investigations and management parameters. Results 41 patients were coded as TIA from HIPE. 39 were a verified TIA diagnosis, with a mean age of 68.7 years. 10.2% were seen by direct GP referral to the Acute Medical Unit (AMU), with the rest attending ED initially. The median length of Stay (LoS) in hospital was 2.75 days. Most patients were admitted under the AMU (33%) or Stroke service (26%), with a shorter LoS if the patient was admitted under these services. 38 patients underwent neuroimaging; 94.8% CT Brain, 84.6% MRI Brain, and 82.1% both CT and MRI imaging. 1 patient went directly for MRI Brain without CT imaging. 82.1% were reviewed by a stroke specialist. Dual Anti-Platelet Therapy (DAPT) was used in 3 patients, single antiplatelet in 21, and oral anticoagulation in 9. 3 patients were discharged without any anti-thrombotic therapy. Conclusion This study highlights areas for improvement in the management of TIA in our facility. Our results have informed the development of a new TIA pathway, which will encourage an ambulatory approach to investigations and management of patients with a TIA. Improved patient-centred outcomes may include improved selection for DAPT, improved neuroimaging efficiency with increased direct to MRI imaging and higher numbers of patients being reviewed by a stroke specialist clinician.

188 Characteristics and outcomes of long-term care facility residents acutely admitted to hospital

Abstract Background Long-term care facility (LTCF) residents represent the frailest members of society and are three times more likely to attend the Emergency Department (ED) than older persons residing in the community. They are also more likely to suffer adverse events when admitted to hospital. This study aims to describe the profile of LTCF residents admitted to hospital in order to inform the implementation of a new nursing home liaison service as part of the Enhanced Community Care program. Methods All LTCF residents with acute admission to a model four hospital in 2022 were identified through the Hospital In-patient Enquiry (HIPE) database, and address of residence was verified using the Integrated Patient Management System (IMPS). Demographic and outcome data including International Classification of Diseases (ICD-10) diagnosis, Length-of-Stay (LoS), in-hospital complications, and mortality were analysed retrospectively. Results There were 724 ED attendances, resulting in 447 acute admissions by 327 residents. The majority of residents (63%, n = 281) arrived to the ED outside of normal working hours. The average age was 84 (range 46–102), and 60% (n = 194) were female. Most were admitted with infection (50%, n = 225), followed by fall with a fracture (16%, n = 70). The median LOS was 8 days (range 0.5–112), and 11% (n = 37) of residents died in hospital. Complications were common with 27% (n = 120) suffering from delirium, 8% (n = 37) falling, and 7% (n = 33) contracting Covid-19 in hospital. Conclusion LTCF residents frequently present with acute unscheduled care episodes. Around 40% of LTCF residents attending ED are not admitted, but those who are have a significant LoS fraught with complications. This study will inform the implementation of the nursing home liaison service with strategies aimed at reduction in potentially avoidable admissions, and alternative provisions of care targeted at common reasons for hospitalisation in this group.

313 Audit of adherence to the National Standards of acute stroke metrics in a tertiary hospital in Dublin, Ireland

Abstract Background Acute stroke is a medical emergency defined as a sudden neurological event of vascular origin caused by decreased cerebral perfusion, preventing oxygen and nutrient supply to parts of the brain, leading to neuronal cell death. The annual cost for the management of stroke patients in Ireland is approximately €489–€805 million. Treatment of ischaemic stroke is very time-dependent and the two main therapies currently available, are intravenous thrombolysis with tissue plasminogen activator (tPA), and endovascular thrombectomy. The aim of this study is to assess the adherence to key performance parameters, but not limited to, such as the onset of symptoms to hospital arrival, time of hospital arrival to imaging, time of hospital arrival to tPA, and time of symptoms onset to recanalization in a tertiary stroke unit as compared to the 2021 Irish National Audit of Stroke report. Methods We carried out a retrospective chart review of 100 stroke patients admitted from 1st January 2022 until 31 December 2022 who were identified using The Hospital In-Patient Enquiry (HIPE). We accessed various hospital sources including PIPE, thrombectomy software, McKesson Radiology and medical charts to retrieve data of interest. This audit was registered with the Hospital Audit Office (CA 2023/112). Results We report here a thrombolysis rate of 18% with 75% receiving tPa within 1 hour of hospital arrival compared to 10% and 56% reported by INAS, respectively. The median door-to-image and door-to-needle for Beaumont Hospital were 24 mins and 42 mins compared to 63 mins and 43 mins reported by INAS, respectively. Conclusion Beaumont Hospital is compliant and performs higher compared to the national average. Inclusion of more study participants is needed to confirm the findings of this report.

Clinical validation of in-hospital stroke diagnosis

ObjectiveIn-hospital stroke cases occur during hospitalization for another diagnosis and reflect a clinically distinct cohort from community-onset stroke. The objective was to validate the diagnostic accuracy of in-hospital stroke identification in stroke audit data at a large teaching hospital. MethodsA retrospective clinical validation of in-hospital stroke diagnoses from two linked data sources was completed for a 2-year period from January 1st 2020 to December 31st 2021. The linked data sources include the Hospital Inpatient Enquiry system which assigns coded stroke diagnoses at discharge and/or the local stroke audit coordinators who work clinically in stroke teams and input additional specific clinical data. Diagnostic sensitivity, specificity and the level of agreement using an unweighted Cohen's Kappa were calculated. ResultsThere were 597 strokes admitted during the 2-year period. The median age was 72 years and 55% occurred in males. In total, 88 cases of in-hospital stroke were clinically validated yielding an in-hospital stroke rate of 15%. The clinical audit coordinator identified in-hospital stroke with higher sensitivity (86%; 95% CI 77%-93%) whereas the coding process was more specific at 96% (95% CI 85% to 99%). Levels of agreement with the clinically validated gold standard sample were moderate for the audit coordinator and coding process with κ = 0.57 and K = 0.42 respectively. When both data sources were combined the level of agreement was substantial (κ = 0.65; p < .000). ConclusionsClinical validation studies are required to reinforce data quality within stroke registers. Combining clinical and administrative data sources improves diagnostic accuracy for in-hospital stroke identification.

Outcome of acute epididymo-orchitis: risk factors for testicular loss

PurposeAcute epididymo-orchitis (AEO) is a common urological condition characterised by pain and swelling of the epididymis which can affect men of any age. The aetiology and to some extent the management of the patient differ between paediatric and young and older adult groups.MethodsA retrospective analysis was performed at the University Hospital Limerick from 2012 to 2016. Hospital In-Patient Enquiry (HIPE) data were obtained for all patients diagnosed with orchitis, epididymitis, epididymo-orchitis or testicular abscess over this 5-year period.Results140 patients were identified, the age range was 0–89, median age 35.6. These were then split into 3 clinical groups, pre-pubertal (Group 1, 0–15-year-olds), sexually active young men (Group 2a, 16–35-year-olds) and men over 35 (Group 2b). Nine patients had an abscess on ultrasound investigation. There was a significant correlation between the presence of an abscess and the need for an orchidectomy (2 patients, P = 0.035). Two patients were reported as having an atrophic testis following AEO and both were in Group 2b.ConclusionOverall, 7/131 (5%) patients had loss or atrophy of a testicle following an episode of AEO. Nineteen patients had further readmissions with AEO (14%).

The decline in transurethral resection of the prostate gland in Irish public hospitals between 2005 and 2021

BackgroundLower urinary tract symptoms due to an enlarged prostate is a common condition. Transurethral resection of the prostate gland (TURP) has been the gold standard treatment. The objective of this study was to assess the trends in the prevalence of TURP procedures in Irish public hospitals within the period of 2005–2021. In addition, we explore the attitudes and practices of urologist in Ireland on this topic. MethodsAn analysis using the Hospital In-Patient Enquiry (HIPE) system using code 37203-00 was undertaken. 16,176 discharges contained the code of interest and had undergone a TURP procedure. The data from this cohort was further analysed. In addition, members of the Irish Society of Urology undertook a bespoke questionnaire to understand the TURP surgery practices. ResultsThere has been a substantial decline in the prevalence of TURP procedures in Irish public hospitals from 2005 to 2021. The number of patients discharged from Irish hospitals with a TURP procedure was 66% less in 2021 compared to 2005. 75% (n = 36) of urologist surveyed felt that the declining TURP numbers were due to lack of resources, access to theatre/inpatient beds and outsourcing. 91.5% (n = 43) felt that the declining TURP numbers would result in a lack of training opportunities for trainees, 83% (39) felt this has increased morbidity for patients. ConclusionsTURP procedures in Irish public hospitals has declined over the 16-year period studied. This decline is a concern for patient morbidity and urology training.

Trends in incidence of ischaemic stroke in people with and without diabetes in Ireland 2005-2015.

We aim to describe the epidemiology of ischaemic stroke and in-hospital mortality associated with stroke among men and women with and without diabetes from 2005 to 2015. Secondary data analysis of national hospital discharge data from the Hospital Inpatient Enquiry database. Stroke incidence and in-hospital mortality rates in people with and without diabetes were calculated. Poisson regression models were used to estimate the incidence rate ratio (IRR) and assess trends over time. The age-adjusted incidence of stroke was twice as high in people with diabetes compared to those without diabetes (men IRR 2.0 [95% CI 1.95-2.06] and women IRR 2.2 [95% CI 2.12-2.27]). The incidence of ischaemic stroke decreased by an average 1.7% per year in men with diabetes and 3.3% per year in women with diabetes. In people without diabetes, the average annual reduction was smaller (0.2% per year in men and 1% per year in women). In-hospital mortality associated with admission with ischaemic stroke was approximately twice as high in those with diabetes compared to those without diabetes among men [IRR 1.81 (1.67-1.97)] and women [IRR 2 (95% CI 1.84-2.18)]. Despite decreases in incidence of ischaemic stroke and associated in-hospital mortality, there remains a twofold increased risk of ischaemic stroke and mortality in people with diabetes. Therefore, priority must be given to management of risk factors for ischaemic stroke in people with diabetes as well as continued development of targeted stroke prevention strategies.

Impact of a one-stop rapid access venous ulcer clinic on inpatient admissions

Venous leg ulcers (VLU) are prevalent and require a large investment of resources to manage. We investigated whether the introduction of a rapid access see-and-treat clinic for VLU patients affected rates of unplanned inpatient admissions with VLU. The Hospital Inpatient Enquiry database was consulted for data on admission rates, length of stay, bed-days used, and costs, across a 4-year period; 2years since the introduction of the clinic, and the 2years prior as a control. Two hundred and eighteen patients admitted with VLU accounted for 2,529 inpatient bed-days, 4.5 (2-6) admissions per month, and a median hospital stay of 7 (4-13) days across the study period. Median admissions decreased from 6 (2.5-8.5) per month before, to 3.5 (2-5) after introduction of the clinic (p = 0.04). Bed-day usage fell from 62.5 (27-92.5), to 36.5 (21-44) days per month (p = 0.035). Admissions and bed-day usage for inpatient management of VLU fell after commencing a one-stop, rapid access clinic.

P301 Outcomes following colectomy for patients with Ulcerative Colitis, ten years of data from a tertiary referral centre

Abstract Background Patients who undergo subtotal colectomy for Ulcerative Colitis (UC) have a persistent risk of colorectal cancer (CRC) in the retained rectum and this increases overtime. There are currently no guidelines for rectal surveillance in this group. We aimed to assess the outcome following colectomy for patients with UC over a ten year period. Methods We conducted a retrospective analysis of patients with UC who underwent colorectal surgery in a tertiary referral centre. The Hospital In-Patient Enquiry system and the St Vincent's Hospital IBD Database were used to identify patients. Patients with colorectal cancer were excluded. Results In a six year period one-hundred and seventy six bowel surgeries were carried out for patients with Inflammatory Bowel Disease. Sixty five of these procedures were performed on patients with UC, eight of which would subsequently be re-diagnosed with Crohn’s Disease. 73.6% (n=42) had a completion proctectomy within ten years, 12% (n=7) were lost to follow up and 5% (n=3) died from non-gastrointestinal disorders. 8.7% (n=5) retained their rectum after ten years. For patients who had a completion proctectomy the median time to surgery was two years. Most of these patients did not have surveillance within the twenty four month time frame. Patients who had a completion proctectomy between three and ten years underwent surveillance endoscopy on average two occasions. All patients in the retained rectum group had surveillance proctoscopy with a median frequency of 2.4 years. The risk of further surgery was a factor for two patients due to obesity and decompensated liver disease. A third patient had an ileorectal anastamosis abroad and continues to have active rectal disease. Dysplasia was found in the rectum of the fourth patient thirteen years post colectomy. The final patient refused surgery but agreed to endoscopic surveillance. A rectal adenocarcinoma was diagnosed ten years post-operation. Conclusion Despite the absence of guidelines for completion proctectomy and/or surveillance of the retained rectal stump, three quarters of our UC patients had undergone completion proctectomy within ten years. A small but significant number of patients have a residual rectal stump after ten years, they require CRC surveillance and clear guidelines on this are needed.