Hospitals In Ireland Research Articles

210 Screening for frailty in the Acute Medical Admissions Unit and examining referral patterns to physiotherapy

Abstract Background Frailty predisposes older people to adverse outcomes following hospitalisation. Physiotherapy can reduce the risk of adverse frailty-related outcomes including functional decline. Research examining frailty and physiotherapy referral in Acute Medical Units is limited. The objective of this study was to estimate the prevalence of frailty in older adults admitted to an Acute Medical Admissions Unit (AMAU), and to explore factors associated with early physiotherapy referral in the frail group. Methods A prospective cohort study was conducted in the AMAU of a large acute hospital in Ireland. Participants were those over 65 years who were admitted to the AMAU. All participants underwent frailty screening on admission using both the Clinical Frailty Scale and Program of Research to Integrate Services for the Maintenance of Autonomy-7 questionnaire. They were defined as frail if positive on at least one of the tools. Referral to physiotherapy and time to referral during hospitalisation was recorded. Multivariable logistic regression was used to explore factors associated with early physiotherapy referral (within 24 hours) for frail participants. Results 210 participants (mean age = 78.3 years, 51.9% female) were included. Frailty prevalence was 71% (n = 149) (95% CI = 64.3–77.0%). Within the frail group, 61.1% (n = 91) experienced early referral to physiotherapy, 15.4% (n = 23) were referred after >24 hours and 23.5% (n = 35) were not referred during hospitalisation. Falls history (Odds Ratio [OR]: 4.08; 95% Confidence Interval [CI]: 1.82–1.94), older age (OR: 1.05; 95%CI: 1.00–1.10) and mobilising with an aid or assistance (OR: 2.42; 95% CI: 1.11–5.27) were associated with early physiotherapy referral in the frail group. Sex and living alone were not. Conclusion Frailty screening in AMAU may increase identification of older people at risk of experiencing adverse outcomes. Routine referral to physiotherapy for people who are deemed frail would ensure more equal access to physiotherapy assessment and treatment which could reduce the risk of adverse outcomes including falls, functional decline, and frailty progression.

237 Drug–drug interactions and the risk of adverse drug reaction hospital admissions in the older population: a prospective cohort study

Abstract Background Drg–Drg Interactions (DDIs) can lead to medication-related harm; the older population is at greatest risk. We estimate DDI prevalence and the average causal effect of DDI exposure on adverse drug reaction (ADR)-related hospital admission in an older (≥65 years) population admitted acutely to hospital in Ireland. We also examine the effect of DDI exposure on health-related quality of life (HRQoL) and Length of Stay (LoS) in hospital. Methods Prospectively collected (2016–17) data from the Adverse Drg Reactions in an Ageing PopulaTion cohort were used (N = 798). Medication (current/recently-discontinued/over-the-counter) and objective clinical data (e.g. renal function) were available. DDIs (which may result in a life-threatening event/permanent detrimental effect) were identified using the BNF and Stockley’s. Causal inference models were developed using directed acyclic graphs. HRQoL was measured using the EQ-5D-5L. Multivariable logistic regression was performed using SAS (v9.4). Results N = 782 patients using ≥2drugs were included, mean age = 80.9(±7.5); 52.2% female; 92.2% polypharmacy (≥5drugs); 45.1% had an ADR-related hospital admission. N = 316 (40.4% [95% Confidence Interval (CI):37.0–43.9]) patients with at least one DDI at hospital admission. After controlling for confounding, the average causal effect of DDI exposure on ADR-related hospital admission was Odds Ratio (OR) = 1.2 [95% CI: 0.9–1.6]. This risk was significantly increased for patients exposed to DDIs which increase bleeding risk (OR: 2.0 [1.3–3.1]); for aspirin-warfarin (OR: 2.8 [1.4–5.7]) and esomeprazole-escitalopram (OR: 3.2 [1.1–10.3] DDIs. Patients with a DDI had a lower HRQoL (mean EQ-5D: 0.49 [±0.39]) compared to those with none (mean EQ-5D: 0.58 [±0.41], p = 0.08). Patients with an ADR-related hospitalisation and DDI had a significantly greater LoS in hospital (8 [Interquartile Range:5–17] days) compared to those with no DDI (6[Interquartile Range: 3–13] days, p = 0.02). Conclusion DDIs are prevalent among older adults on acute admission to hospital, and increase the risk of ADR-related hospitalisation, significantly for patients with DDIs that increase bleeding risk. Patients with a DDI had lower HRQoL, and prolonged LOS in hospital.

341 Auditing the timing of CT-Brain and Angiograms in suspected acute stroke

Abstract Background Timing of neuroimaging play a key role in the management and ultimate outcomes of patients presenting to hospital with a suspected acute stroke. The NICE Guidelines on the initial management of suspected acute stroke and the NHS National Stroke Service Model set a target of less than 20 minutes between arrival to hospital and having a CT-Brain and CT-Angiogram performed, analysed, and reported. A clinical audit was performed looking at the timing of all CT-Brain studies performed in 2022 at a level three hospital in Ireland where acute stroke was the suspected presentation. Methods A total of 206 CT-Brain and CT-Angiogram studies were included in the audit. The time of the patients’ registration in the emergency department was compared to the timestamp on NIMIS of the completion of each CT study and of the time of publication of the radiologist’s report. For patients already admitted on a hospital ward, the time that the CT study was requested was used in lieu of arrival time. Results The average time between arrival in the emergency department and the completion of CT-Brain was 82 minutes. The average time between the completion of the CT and the publication of the radiologist’s report was 26 minutes, however many studies had verbal reports delivered to the requesting physician prior to publication of the report. Altogether, the average time for the performance and reporting of a CT-Brain and Angiogram in patients with suspected acute stroke was 108 minutes. Conclusion The average of 108 minutes from door to scanner to reported CT-Brain and Angiogram is significantly longer than the 20 minutes recommended by the NICE Guidelines. This hospital serves a large, rural catchment which makes late presentations common, adding to the urgency of neuroimaging for these patients. In future, key areas of in-hospital delay in CT performance and reporting should be identified and given close attention.

Exploring facilitators and barriers associated with oral care for inpatients with dysphagia post-stroke.

To explore the attitudes, facilitators and barriers in providing oral care for inpatients with dysphagia post-stroke as perceived by healthcare professionals. Dysphagia is a common complication of stroke and is associated with a higher incidence of aspiration pneumonia, malnutrition and dehydration. In the acute phase of stroke recovery, a dental professional is not usually part of the multidisciplinary team caring for the patient and oral care is the responsibility of the healthcare professionals in the stroke unit. There is a lack of high-quality evidence to demonstrate the most effective method of providing oral care for patients with dysphagia post-stroke. This was a single-site study conducted with healthcare professionals working in the Stroke Unit of Cork University Hospital in Ireland, using focus groups and a qualitative thematic analysis approach. A total of three focus groups were conducted in the Stroke Unit with 17 healthcare professionals. The focus groups included representation from all healthcare professional groups providing direct clinical care to patients on the Stroke Unit including geriatric medicine, dietetics, speech and language therapy, healthcare assistance, nursing, occupational therapy and physiotherapy. A qualitative thematic analysis was carried out and seven overarching themes emerged from the data. Three themes related to facilitators to providing oral care for this patient group: (i) a focus on oral care in both policy and practice, (ii) expanding professional roles in the provision of oral care, (iii) perceived importance of oral care in recovery and rehabilitation. Four themes related to barriers to the provision of oral care for this patient group: (i) lack of confidence and concerns related to the perceived risk for patients with dysphagia, (ii) unique challenges of patient and stroke-related factors, (iii) lack of resources and time and (iv) perceived importance of oral care in recovery and its relative importance with competing demands. Members of the stroke multidisciplinary team believe that they all have a part to play in the delivery of oral care for patients with dysphagia post-stroke. Opportunities exist for the development of multidisciplinary interventions to improve the oral cavity assessment and oral care provided in the Stroke Unit.

Admission ultrasonography as a means of identifying unrecognized fetal compromise in term singleton pregnancies at the onset of labor – a feasibility study

Objectives Apparently uncomplicated low-risk pregnancies, especially first time births, account for a significant proportion of adverse birth outcomes. Improved risk stratification with a simple bedside scan on admission in early labor could potentially reduce adverse intrapartum outcomes. The aim of this feasibility study was to assess a cohort of low-risk subjects with admission ultrasonography at the onset of labor with a view to conducting a future randomized controlled trial (RCT). The objectives were three-fold; i) to determine the logistics of performing a labor admission ultrasound scan ii) to establish whether abnormal ultrasound features can be identified and iii) whether they are associated with emergency delivery and/or poor condition of the neonate at birth. Methods We performed a prospective cohort study of 295 participants with term singleton cephalic pregnancies admitted in early labor or for labor induction with non-fetal indications. The setting was a university teaching hospital in Ireland with almost 8000 births annually. A bedside ultrasound scan was performed to assess fetal biometry, amniotic fluid volume and placental maturity. Patients and their babies were followed up until hospital discharge. The outcomes of interest included image quality, time to perform a scan, oligohydramnios (Single Deepest Pool ≤ 2 cm), small for gestational age (SGA; abdominal circumference <10th centile), mature placenta (Grannum 2 or 3), pathological CTG, emergency cesarean section (CS), fetal acidosis (cord arterial pH <7.10 or base excess <-12.0), low Apgar score <7 at 5 min and neonatal unit admission. Results Image quality was optimal in 274 of the 295 scans (93%) and 271 (92%) were completed in less than 10 min. Of this low-risk population, 67 of 294 (23%) had oligohydramnios, 11 (4%) were small for gestational age and 87 (30%) had a mature placenta (Grannum grade 2). The incidence of pathological CTG and emergency CS was higher among patients with oligohydramnios than those with a normal scan but did not reach statistical significance; Odds Ratio 3.40 (95% Confidence Intervals 0.55 to 20.92) and OR 1.43 (95% CI 0.66 to 3.08) respectively. The mean birthweight was significantly lower in those with oligohydramnios −139 g (95% CI −248 to −30) and admission scan detected SGA −357 g (95% CI −557 to −137). Adverse perinatal outcomes were uncommon with a higher incidence of fetal acidosis (pH < 7.10) in the oligohydramnios group. The incidence of neonatal unit admission >24 h was higher in the oligohydramnios group but not statistically significant; OR 3.75 (95% CI 0.61 to 22.97). Results for SGA alone were non-significant and results for oligohydramnios and SGA combined were similar to those for oligohydramnios alone. Conclusions Admission ultrasonography is feasible in a routine clinical setting, but evidence of benefit is weak and does not currently justify a randomized controlled trial.

The burden of attempted hanging and drowning presenting to hospitals in Ireland between 2007 and 2019: a national registry-based study

PurposeTo measure the impact of hospital-treated self-harm by hanging and drowning in Ireland in 2007–2019 and identify risk factors for these methods of self-harm.MethodData on all self-harm presentations to Irish hospitals between 2007 and 2019 were obtained from the National Self-Harm Registry Ireland, a national self-harm surveillance system. Multinomial regression was used to explore factors associated with attempted hanging and drowning.ResultsThe age-standardised incidence rate of attempted hanging and drowning increased by 126% and 45%, respectively, between 2007 and 2019. The incidence of both methods was highest among young people aged 15–24 years. The odds of presenting to hospital for attempted hanging were highest in males (aOR 2.85, 95% CI 2.72–3.00), people experiencing homelessness (aOR 1.32, 95% CI 1.16–1.49) and individuals living in the capital, Dublin (aOR 1.23, 95% CI 1.17–1.29). The odds of presenting for attempted drowning were highest in males (aOR 1.68, 95% CI 1.58–1.78) and people experiencing homelessness (aOR 2.69, 95% CI 2.41–2.99).ConclusionThe incidence of hospital-treated self-harm by hanging and drowning is increasing in Ireland and is highest among adolescents and young adults. Males and people experiencing homelessness may be at highest risk and warrant targeted preventive interventions.

An investigation into exercise prescription post-COVID-19 pandemic amongst Non-Consultant Hospital Doctors in an acute hospital setting.

Being sedentary is an independent risk factor for severe COVID-19 infection, suggesting the important role physical activity (PA) has as a modifiable risk factor for COVID-19 outcome. The aim of this study was to evaluate NCHD's exercise prescribing practices and establish how these related to their knowledge, attitudes, and demographics and if their practices had changed since the COVID-19 pandemic began. An online survey was emailed to NCHDs working in city centre teaching hospitals in southern Ireland. Using a combination of forced choice items and five-point Likert scales, questions examined NCHD's knowledge, attitudes, and practices of exercise prescription. For education, 30% of participants were able to correctly answer both WHO PA guidelines. 10% agreed that they knew where to refer patients for specialist exercise programs. For attitudes, 100% of participants in this study agreed that PA played a role in the prevention of disease. For practices, 36% of participants did not prescribe exercise at all. No participant strongly agreed with being confident in prescribing exercises. 90% did not increase their exercise prescribing practices since the introduction of pandemic restrictions. Despite an overall positive attitude towards PA in this study, findings suggest exercise prescribing was not carried out regularly amongst the majority of participants. There was a lack of confidence and knowledge regarding exercise prescribing amongst NCHDs. The majority of NCHDs have not changed their exercise prescribing practices since the COVID-19 pandemic began. Findings suggest there is an urgent need for educational tools and supports to assist doctors with exercise prescribing.

Pilot study of the implementation of G8 screening tool, Cognitive screening assessment and Chemotherapy Toxicity assessment in older adults with cancer in a Tertiary University Hospital in Ireland.

Comprehensive geriatric assessment (CGA) is recommended by international guidelines prior to initiation of systemic anti-cancer treatment (SACT). In practice, CGA is limited by time constraints, lack of resources and expert interpretation. The primary objective of this pilot study was to establish the prevalence of frailty (assessed by G8), cognitive impairment (assessed by Mini-Cog), and risk of chemotherapy toxicity (assessed by CARG Chemo-Toxicity Calculator) among patients (pts) ≥65 years commencing SACT. We selected these three screening tools due to the ease of conducting them in a busy outpatient setting. In addition, they have been validated to predict frailty and risk of toxicity from SACT among older adults with cancer. Eligible participants were identified from medical oncology clinics. Assessments were conducted in an outpatient setting by treating physicians. Pt records were reviewed to gather demographic and cancer details. Statistical analyses were conducted using SPSS statistical software. Sixty-three participants were enrolled. The mean age of participants was 73yrs (range=65-88). Thirty-three (52.4%) were female and 30 (47.6%) were male. The majority (n=38, 60.3%) had metastatic cancer. The mean G8 score was 11.9 (range=6-19). Eighty-three percent had a G8 score ≤14. Mini-Cog was positive in 13 pts (21%). The mean CARG score was 7.5 (range=0-16), and 80% had a risk of at least 50% grade ≥3 toxicity. Of these, 48 (76.2%) received chemotherapy and 15 (23.8%) received non-cytotoxic SACT. In multi-variate analyses, age, cancer type, treatment type, and disease stage did not impact G8, Mini-Cog, or CARG scores. Our study has several limitations but suggests that the majority of older adults with cancer would qualify for formal CGA assessment. The risk of high-grade toxicity from SACT is substantial in this cohort. Chronological age was not found to negatively impact pts' frailty, cognition, or risk of toxicity.

Tobacco-free campuses - a pipe dream? A survey of current smoking cessation practice in mental health units in Ireland.

Smoking and vaping are prohibited on Ireland's Health Service Executive (HSE) campuses. The HSE states that there is no evidence to suggest vaping is less damaging than cigarettes. Recent meta-analyses have shown that e-cigarettes are in fact less dangerous and can help smokers quit. Our study analyses the current smoking policies in place in mental health 'approved centres' in Ireland, what is being done to help smokers quit while in-patients and the level of support among staff for the introduction of e-cigarettes as a harm reduction tool. Clinical nurse managers from each mental health approved centre were surveyed to assess adherence to smoking policies. Only 5% of surveyed units enforce the HSE's Tobacco Free Campus Policy; 55% of units supported the idea of using e-cigarettes to help patients quit cigarettes. Ireland's hospital campuses are not tobacco free. Changes need to be made to our smoking policies and their enforcement.

The importance of communication and involvement in decision-making: A study in Ireland exploring birth satisfaction using the Birth Satisfaction Scale-Revised (BSS-R).

Evaluation in healthcare services has become a priority, globally1. The Government of Ireland has highlighted the importance of stakeholder engagement to identify the needs of women in the design and delivery of high-quality health services, driven by necessity rather than financial ability2. The Birth Satisfaction Scale-Revised (BSS-R), an internationally validated tool, and recommended for measuring childbirth satisfaction by the International Consortium for Health Outcomes Measurement (ICHOM)3; however, it has yet to be considered in the Irish context. The aim of the study was to explore birth satisfaction with a sample of new mothers in Ireland. A mixed-methods study was conducted including a survey that involved collection of data from the BSS-R 10-item questionnaire from 307 mothers over an 8-week period in 2019, in one urban maternity hospital in Ireland. Quantitative and qualitative data were collected. Qualitative data from the free-text comments of the survey questions were analyzed using content analysis. Overall, women reported positive relationships with their care providers and were satisfied with the communication and support they received, as well as high levels of control and choice. Postnatal care, however, was highlighted as being less satisfactory with staffing levels described as inadequate. Understanding women's birth experiences and what is important to them could facilitate midwives and other health professionals to improve the quality of their care and develop guidelines and policies that focus on women and their families' needs. The vast majority of women rated their birthing experience as extremely positive. The main elements of care that contributed to a positive birthing experience for women were quality relationships with clinicians, choice and control, and emotional safety.

P03 A retrospective review of the safety and efficacy of dalbavancin at Ireland’s largest acute medical hospital

Abstract Background Dalbavancin is a second-generation lipoglycopeptide antibiotic. It is licensed in Ireland and the United Kingdom for the management of acute skin and soft tissue infections. International colleagues report treatment success in its use for patients who are unable to stay in hospital for prolonged periods and not suitable for OPAT.1 We reviewed the use of dalbavancin at St. James’s Hospital, Dublin, which is the largest hospital in Ireland with over 700 acute beds. We are located in Dublin’s inner city which experiences significant socio-economic deprivation. Methods We used the electronic patient records at St. James’s Hospital to capture all uses of dalbavancin from August 2018 to September 2022. We established baseline demographics, indication, microbiological characteristics, if there was oversight by ID/micro, safety and treatment outcomes. We considered how many hospital days were saved if a patient was changed to dalbavancin and discharged home compared with how long they would have required to stay in hospital to pursue conventional treatment. One hospital day in an acute bed is estimated to cost 800€. Results We identified 23 patients who met the inclusion criteria. Baseline demographics are shown in Table 1. The most common indication was endovascular infection (35%) and skin and soft tissue infection (35%) (Figure 1). Most patients were not bacteraemic. Staphylococcus aureus was the most common organism identified on blood culture (Figure 2). In total, 322 hospital beds were saved, which equates to 257 600 EUR. No patients had an adverse drug reaction. 100% of cases were discussed with micro or ID. Conclusions Dalbavancin is a safe and effective drug. It is another tool that can be used when caring for patients who are experiencing unstable housing and challenging social circumstances. Our experience has found 0 adverse events, 69% of patients experienced treatment success (this increases to 88.8% if we exclude those lost to follow up). This is an important finding considering 17% of indications were considered ‘on label’. Dalbavancin can save money on hospital beds and also reduces non-recyclable plastic associated with repeated doses of IV antibiotics.

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.

Retrospective Analysis to Assess the Admission Rate Trends in an Irish Public Hospital between February 2014-September 2022

Introduction:As the population in the Republic of Ireland increases, the number of Emergency Department (ED) attendances and admission rates increase, placing significant pressure on the health care system, the limited staff and hospital resources.The aim of this study is to assess the admission rates in an Irish Public Hospital Emergency Department between 2014 and 2022.Method:This retrospective study was done using information provided by the Health Service Executive Integrated Patient Management System. Data for the period between February 2014 to September 2022 were collected. From the data, the admission rate can be calculated and trends observed.Results:Emergency department attendance rates have increased from 29,236 to 42,637 between 2014 and 2019, with a decline noticed in 2020 to 37,751 and a drastic increase in 2021 at 43,182. Currently up until September 2022 there has been 35,503 attendances and 8,570 admissions, with an admission rate of 24.14%. The number of admissions has ranged from 9,056 in 2014 to the highest being 12,175 in 2019. This means the admission rate is averaging between 24% to 31% per annum, with the highest being 31,04% in 2015, and the lowest in 2017 at 24,99%.Conclusion:This study showed a steady increase in attendances per annum, which correlates to an increase in the total admissions from 2014 to 2022, with approximately one third of all ED attendances resulting in admission. The increase in attendances and admission rate could be related to the population growth from 4.6 to 5.1 million from 2014 to 2022. The decrease in attendances during 2020 could be attributed to the Covid-19 pandemic restrictions being implemented, and lifted in 2021 which showed a drastic increase in ED numbers. Ultimately, the increase in admissions will place a burden on the Public Hospitals in Ireland.

AB015. SOH23ABS_169. Surgical prophylactic antibiotics: compliance with local and AMRIC guidelines

Background: Antimicrobial prophylaxis is a critical step in preventing surgical site infection. The Antimicrobial Resistance and Infection Control committee (AMRIC) position statement summarises current guidelines on the maximum recommended duration of antibiotic prophylaxis for each surgical speciality. Our aim is to audit the use of prophylactic antibiotics by the breast surgery unit at one teaching hospital in Ireland against local and AMRIC guidelines.

A Delphi Consensus Study to Define Non-Consultant Hospital Doctor Competencies Essential for a Focussed Curriculum in Major Emergency Management

Introduction:In this era of increasingly fragile hospital systems, major emergency preparation is firmly being placed under the spotlight. The response to major emergencies requires the mobiliZation of numerous resources to ensure an effective, coordinated response. Yet, studies confirm a global deficit in the knowledge and skills of staff responding to these events in Ireland. Non-consultant hospital doctors (NCHDs) provide a useful and necessary surge response during these events, but currently there are no training programs specifically focused on their major emergency training requirements. The aim of this research was to define the essential elements of a focused curriculum for non-consultant hospital doctors responding to a major emergency (ME).Method:A two-step process was employed. Initially, a comprehensive ME competency set was compiled from relevant literature, consulting field-specific experts and from current ME training programs. A sample of experts was paneled from several acute hospitals in Ireland using purposive and snowball recruitment. A modified Delphi process, using on-line surveys, was utilized to identify the competencies deemed essential for NCHDs responding to an ME event.Results:Three Delphi rounds were required to complete this study. Of the 116 initial survey items, 68 competencies were confirmed as essential NCHD competencies, a total reduction of 40%. A 70% consensus rate was applied to 71 survey items in the final round, resulting in an agreement in 68 competencies (96%). A preponderance of the rejected competencies were specific to managerial and administrative tasks, whilst many retained competencies related to direct clinical care.Conclusion:This study has defined the essential elements of a curriculum for NCHD doctors responding to a major emergency in Ireland, using the Delphi methodology. This derived competency set should be useful to national bodies, regional organizations, and hospital stakeholders to allow the creation of bespoke NCHD major emergency training programs.

Experiences of shared decision making in acute hospitals: A mixed methods secondary analysis of the Irish National Inpatient Experience Survey

IntroductionThis study explored patient experiences of shared decision making (SDM) in public acute hospitals in Ireland. MethodsQuantitative and qualitative data from three years of the Irish National Inpatient Experience Survey were analysed. Survey questions were mapped to definitions of SDM and subjected to principal components analysis. Three SDM subscales (care on the ward; treatments; discharge) and one overall SDM scale were created. Differences in experiences of SDM by aspects of care and patient group were assessed. Thematic analysis of qualitative responses was undertaken. Results39,453 patients participated in the survey. The mean SDM experience score was 7.60 ± 2.43. Experience scores were highest on the treatments sub-scale, and lowest during discharge. Patients who had a non-emergency admission, those aged 51–80 years and men had more positive experiences than other groups. Patient comments highlighted that opportunities to clarify information and facilitation of families/caregivers in SDM were found to be lacking. ConclusionThere were differences in experiences of SDM by aspects of care and patient group. Practice implicationsEfforts to improve SDM in acute hospitals are required, particularly at the time of discharge. SDM may be improved by facilitation of more time for discussion between clinicians and patients and/or their families/caregivers.

MP02-10 UROLOGY DIRECTED MANAGEMENT OF HIGH GRADE RENAL TRAUMA IS ASSOCIATED WITH A LOW RATE OF EMERGENCY NEPHRECTOMY/RENORRHAPHY

You have accessJournal of UrologyCME1 Apr 2023MP02-10 UROLOGY DIRECTED MANAGEMENT OF HIGH GRADE RENAL TRAUMA IS ASSOCIATED WITH A LOW RATE OF EMERGENCY NEPHRECTOMY/RENORRHAPHY Aisling Fawaz, Robert Keenan, and Elaine Redmond Aisling FawazAisling Fawaz More articles by this author , Robert KeenanRobert Keenan More articles by this author , and Elaine RedmondElaine Redmond More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Major trauma care in Ireland is managed through a multidisciplinary collaborative approach between trauma surgeons and organ subspecialists e.g. urologists, cardiothoracic surgeons, neurosurgeons etc. Thus the urology service directs the management of all urological trauma irrespective of the grade of injury or other organ involvement. This is in contrast to the management of trauma care in other jurisdictions such as the United States where the majority of trauma cases are primarily managed by trauma surgeons with other specialities consulted as required. One recent study found that urology was consulted in only 15% of high grade renal trauma cases presenting to their institution even though urology consultation was associated with a lower nephrectomy rate (36.4% vs 78.8%).1 We hypothesised that the standardised urology directed care of renal injuries in Ireland would be associated with comparatively higher rates of renal preservation and reduced intervention/nephrectomy. The aim of our study was to evaluate the management of high grade renal trauma in Ireland using data derived from the Irish Major Trauma Audit which is stored on the Trauma Audit and Research Network (TARN) database. METHODS: The TARN database was used to identify all cases of significant renal trauma presenting to the 26 trauma receiving hospitals in Ireland between 2014 and 2020. Demographic data, mechanism of injury, injury characteristics, management and patient outcomes were analysed. RESULTS: There were a total of 426 renal trauma cases recorded during the study period, of which 305 patients had a high grade renal injury. The majority of patients in this group were male (241 (79%)). The median age was 28 years (range: 0.3-93.9 years). There were 276 cases of blunt renal trauma (90%) and 29 cases of penetrating trauma (10%). The most common cause for blunt renal trauma was road traffic accident. 65 patients (21%) required blood or blood products. Seven patients underwent emergency nephrectomy or renorraphy (2%). CONCLUSIONS: The need for emergency nephrectomy due to high grade renal trauma in Ireland is exceedingly rare. We conclude that an integrated multidisciplinary approach to trauma care results in a higher likelihood of avoiding intervention in this cohort of patients. 1Wang SL, Agrawal P, Rostom M, Gupta N, et al. Urology Consult: Association with Renal Trauma Imaging and Intervention. Urology 2022 (In press) Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e14 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aisling Fawaz More articles by this author Robert Keenan More articles by this author Elaine Redmond More articles by this author Expand All Advertisement PDF downloadLoading ...

Psychotropic Medication Prescribing to Patients with Dementia Admitted to Acute Hospitals in Ireland.

Psychotropic medications are commonly prescribed to people with dementia (PwD) for non-cognitive symptoms of dementia (NCSD), but have significant risks. A national audit was performed in acute hospitals in the Republic of Ireland (ROI) to establish baseline practice prior to the launch and implementation of a National Clinical Guideline on the appropriate prescribing of psychotropic medications for NCSD. The objective of this study was to analyse psychotropic prescribing patterns and compare these with international data and with existing (limited) data from a previous audit round. The pooled anonymous dataset from the second round of the Irish National Audit of Dementia Care (INAD-2) was analysed. The audit had collected retrospective data from 30 random healthcare records from each of 30 acute hospitals in 2019. Inclusion criteria were a clinical diagnosis of dementia of any type, hospital stay of 72 hours or more, and discharge or death within the audit period. Most hospitals (87%) self-audited their healthcare records, but a random sample of six healthcare records (20%) from each hospital were re-audited by a highly trained healthcare auditor. The audit tool was based on a tool used in the England and Wales National Audit of Dementia audit rounds (Royal College of Psychiatrists), adapted to the Irish healthcare setting and national priorities. In total, 893 cases were included, as one hospital could not retrieve 30 cases even within a more prolonged audit period. The sample comprised 55% females and 45% males; the median age was 84 years (interquartile range 79-88 years) and the majority (89.6%) were >75 years of age. Only 52% of healthcare records specified the type of dementia; within these, the most common diagnosis was Alzheimer's disease (45%). Most PwD (83%) were receiving psychotropic medication on admission; 40% were prescribed new or increased psychotropic medication during admission, mainly for medical indications, including end-of-life care and delirium. Anticonvulsants or cognitive enhancers were rarely prescribed for NCSD in hospital. However, new/increased antipsychotic medication was prescribed for NCSD in 11.8-17.6% of the total cohort, while 4.5-7.7% were prescribed a benzodiazepine for anxiety or NCSD. Overall, there was poor documentation of risk/benefit, or of discussion with the patient/family, and apparently inadequate review for efficacy and tolerability. Concurrently, acetylcholinesterase inhibitors appeared to be underused for cognitive impairment in the community. This audit provides baseline data on psychotropic medication prescription for NCSD in Irish hospitals prior to a specific Irish guideline on this topic. Reflecting this, most PwD were receiving psychotropic medications on admission, and many were prescribed new/increased psychotropic medication in hospital, often without evidence of appropriate decision making and prescribing processes.

The Accuracy of Point-of-Care Ultrasound (POCUS) in Acute Gallbladder Disease.

There is increasing recognition that point-of-care ultrasound (POCUS), performed by the clinician at the bedside, can be a natural extension of the clinical examination-the modern abdominal "stethoscope" and provides an opportunity to expedite the care pathway for patients with acute gallbladder disease. The primary aims of this study were to benchmark the accuracy of surgeon-performed POCUS in suspected acute gallbladder disease against standard radiology or pathology reports and to compare time to POCUS diagnosis with time to definitive imaging. This prospective single-arm observational cohort study was conducted in four hospitals in Ireland, Italy, and Portugal to assess the accuracy of POCUS against standard radiology in patients with suspected acute biliary disease (ClinicalTrials.govIdentifier: NCT02682368). The findings of surgeon-performed POCUS were compared with those on definitive imaging or surgery. Of 100 patients recruited, 89 were suitable for comparative analysis, comparing POCUS with radiological findings in 84 patients and with surgical/histological findings in five. The overall global accuracy of POCUS was 88.7% (95% CI, 80.3-94.4%), with a sensitivity of 94.7% (95% CI, 85.3-98.9%), a specificity of 78.1% (95% CI, 60.03-90.7%), a positive likelihood ratio (LR+) of 4.33 and negative likelihood ratio (LR) of 0.07. The mean time from POCUS to the final radiological report was 11.9 h (range 0.06-54.9). In five patients admitted directly to surgery, the mean time between POCUS and incision was 2.30 h (range 1.5-5), which was significantly shorter than the mean time to formal radiology report. Sixteen patients were discharged from the emergency department, of whom nine did not need follow-up. Our study is one of the very few to demonstrate a high concordance between surgeon-performed POCUS of patients without a priori radiologic diagnosis of gallstone disease and shows that the expedited diagnosis afforded by POCUS can be reliably leveraged to deliver earlier definitive care for patients with acute gallbladder pathology, as the general surgeon skilled in POCUS is uniquely positioned to integrate it into their bedside assessment.

Implementation of Ireland's first state-funded day-case total hip arthroplasty programme.

Over the last two decades, many elective procedures have transitioned to day-case surgery thanks to the introduction of 'enhanced recovery' protocols. Only recently has total hip arthroplasty been considered a candidate for day-case surgery, as it was once associated with significant pain, mobility impairment and prolonged postoperative recovery. The National Orthopaedic Hospital Cappagh became the first public hospital in Ireland to set up a day-case total hip arthroplasty service in June 2018, and since then has performed over 109 such cases. We outline our day-case total hip arthroplasty pathway, with specific focus on anaesthetic considerations. We report rates of failed discharge and readmission. We achieved successful same-day discharge in 90.8% of our first 109 cases. Readmission rate was 4.6%. Our experience of implementing a day-case total hip arthroplasty pathway was highly positive and congruent with expectations from the literature. With appropriate patient selection and education, day-case total hip arthroplasty is not just safe, but of benefit to both patients and healthcare systems.