Proceedings of the Intern Section of the Royal Academy of Medicine in Ireland (RAMI) on Saturday 1st February 2020, Venu
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ABSTRACTS
Proceedings of the Intern Section of the Royal Academy of Medicine in Ireland (RAMI) on Saturday 1st February 2020, Venue: The Pillar Centre for Transformative Healthcare, Mater Misericordiae University Hospital, Dublin
# Royal Academy of Medicine in Ireland 2020
PLATFORM PRESENTATIONS: CASE PRESENTATIONS An Analysis Of Hospital Coding Data On Cellulitis Admissions At A Tertiary Referral Centre To Inform Service Development O’Farrell R, O’Connell J, DeBarra E, McConkey S, McNally C Infectious Disease Dept., Beaumont Hospital, Dublin DNE/RCSI Background: Cellulitis is a frequent cause of hospital admission to public hospitals1. Our aim was to describe and compare cellulitis hospital admissions under medical and surgical specialties in our tertiary referral centre to inform service development. Methods: We used the National Quality Assurance and Improvement System (NQAIS) to extract all admissions with cellulitis from 1/1/2018-31/ 12/2018. Data points extracted included age, gender, length of stay, risk factors for cellulitis, readmission rates, Charlson Score and procedures performed. We used the Mann Whitney U test to compare lengths of stay. Results: There were 250 admissions with cellulitis. 169/250(66.1) were admitted by a surgical specialist, 81/250(33.9) by a medical. In total there was 2390 bed-days used due to cellulitis. Surgical intervention was required in 2/81(2.5%) admissions under a medical specialist and 8/169(4.7%) of admissions under a surgical specialist. The mean Charlson score 3.53(SD=6.5) in those under a medical specialist and 1.25(SD=3.4) in those under a surgical specialist. Readmission occurred in 19/169(11%) who were discharged from a surgical specialist and 10/ 81(12.3%) in those under a medical. The mean LOS was 15.1(SD=30.7) days under medical specialists and 6.9(SD=10.7) days under surgical. There was a statistically significant difference in the mean lengths of stay when those with a Charlson Score of 10 or less was compared with those with a Charlson Score greater than 10 (8.8 days (SD=19.8) vs. 21 days (SD=17.2), p3 months, with initial NYHA Class 2 or more with a reduced ejection fraction 2000ml/24hours), resulting in profound dehydration and admission to critical care. MDT input proved imperative while investigations to identify a reversible cause were inconclusive. The patient was eventually weaned off TPN at POD 75 and was discharged home on IV fluids on POD 145. Discussion: Intestinal Failure has been recently classified as Type 1-3 by European Society for Parenteral and Enteral Nutrition, based on disease onset and anticipated outcomes.1 Our patient’s clinical course and protracted 152-day hospital admission corresponded with a Type 2 Intestinal Failure. This is a relatively uncommon subtype, associated with
Ir J Med Sci (2020) 189 (Suppl 4):S29–S81 septic and metabolic complications. This type of IF requires TPN over weeks to months, often requires intensive care and management of a multi-disciplinary IF team and carries an in-hospital mortality of 9.613%.1 Refere
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