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Grant C, O'Connell S, Lillis D, Moriarty A, Fitzgerald I, Dalby L, Bannan C, Tuite H, Crowley B, Plunkett P, Kennedy U, McMahon G, McKiernan S, Norris S, Hughes G, Shields D, Bergin C, Opt-out screening for HIV, hepatitis B and hepatitis C: observational study of screening acceptance, yield and treatment outcomes, Emerg Med J, 2019,
Notes: [Abstract BACKGROUND: We initiated an emergency department (ED) opt-out screening programme for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) at our hospital in Dublin, Ireland. The objective of this study was to determine screening acceptance, yield and the impact on follow-up care. METHODS: From July 2015 through June 2018, ED patients who underwent phlebotomy and could consent to testing were tested for HIV, HBV and HCV using an opt-out approach. We examined acceptance of screening, linkage to care, treatment and viral suppression using screening programme data and electronic health records. The duration of follow-up ranged from 1 to 36 months. RESULTS: Over the 36-month study period, there were 140 550 ED patient visits, of whom 88 854 (63.2%, 95% CI 63.0% to 63.5%) underwent phlebotomy and 54 817 (61.7%, 95% CI 61.4% to 62.0%) accepted screening for HIV, HBV and HCV, representing 41 535 individual patients. 2202 of these patients had a positive test result. Of these, 267 (12.1%, 95% CI 10.8% to 13.6%) were newly diagnosed with an infection and 1762 (80.0%, 95% CI 78.3% to 81.7%) had known diagnoses. There were 38 new HIV, 47 new HBV and 182 new HCV diagnoses. 81.5% (95% CI 74.9% to 87.0%) of known patients who were not linked were relinked to care after screening. Of the new diagnoses, 86.2% (95% CI 80.4 to 90.8%) were linked to care. CONCLUSION: Although high proportions of patients had known diagnoses, our programme was able to identify many new infected patients and link them to care, as well as relink patients with known diagnoses who had been lost to follow-up.],
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Patrick K Plunkett, Capacity - A quart into a pint pot?, Doolin Memorial Lecture, Royal College of Surgeons of Ireland, December 3rd, 2016, Irish Medical Organisation,
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O'Connell S, Lillis D, Cotter A, O'Dea S, Tuite H, Fleming C, Crowley B, Fitzgerald I, Dalby L, Barry H, Shields D, Norris S, Plunkett PK, Bergin C., Opt-Out Panel Testing for HIV, Hepatitis B and Hepatitis C in an Urban Emergency Department: A Pilot Study, PLoS One, 11, (3), 2016,
Notes: [OBJECTIVES: Studies suggest 2 per 1000 people in Dublin are living with HIV, the level above which universal screening is advised. We aimed to assess the feasibility and acceptability of a universal opt-out HIV, Hepatitis B and Hepatitis C testing programme for Emergency Department patients and to describe the incidence and prevalence of blood-borne viruses in this population. METHODS: An opt-out ED blood borne virus screening programme was piloted from March 2014 to January 2015. Patients undergoing blood sampling during routine clinical care were offered HIV 1&2 antibody/antigen assay, HBV surface antigen and HCV antibody tests. Linkage to care where necessary was co-ordinated by the study team. New diagnosis and prevalence rates were defined as the new cases per 1000 tested and number of positive tests per 1000 tested respectively. RESULTS: Over 45 weeks of testing, of 10,000 patient visits, 8,839 individual patient samples were available for analysis following removal of duplicates. A sustained target uptake of >50% was obtained after week 3. 97(1.09%), 44(0.49%) and 447(5.05%) HIV, Hepatitis B and Hepatitis C tests were positive respectively. Of these, 7(0.08%), 20(0.22%) and 58(0.66%) were new diagnoses of HIV, Hepatitis B and Hepatitis C respectively. The new diagnosis rate for HIV, Hepatitis B and Hepatitis C was 0.8, 2.26 and 6.5 per 1000 and study prevalence for HIV, Hepatitis B and Hepatitis C was 11.0, 5.0 and 50.5 per 1000 respectively. CONCLUSIONS: Opt-out blood borne viral screening was feasible and acceptable in an inner-city ED. Blood borne viral infections were prevalent in this population and newly diagnosed cases were diagnosed and linked to care. These results suggest widespread blood borne viral testing in differing clinical locations with differing population demographic risks may be warranted.],
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Kelleher E, Plunkett PK, O'Dwyer AM, Cooney J, Emergency Medicine Trainees' Confidence in Psychiatric Assessments, Psychosomatics, 55, (4), 2014, p415 - 417,
Notes: [The Royal College of Psychiatrists recommends that emergency medicine (EM) personnel should feel confident in making an initial assessment of people with mental health problems. Trainees in EM are often the first doctors to assess and manage patients with psychiatric problems. Such patients constitute up to 35% of Emergency Department (ED) presentations, with the most frequent problems being self-harm (31%), substance misuse (20%), psychosis (17%), and mood disturbance (15%). The College of Emergency Medicine recently issued a toolkit for Mental Health in EDs in February 2013. It recommends that "mental health should feature specifically within junior induction" and that liaison psychiatry have a key role in the education of staff ePub ahead of print doi: 10.1016/j.psym.2013.07.006],
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S O'Connell, Lillis D, O'Dea S, H Tuite, C Fleming, D Shields, S Norris, B Crowley. P Plunkett, C Bergin , Results of a Universal Testing Programme for Blood Borne Viruses in an Urban Emergency Department, including Rates of Diagnosis and Linkage to Care, AASLD The Liver Meeting, Boston, MA, November 7-11 2014, 2014,
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Iyer PM, McNamara PH, Fitzgerald M, Smyth L, Dardis C, Jawad T, Plunkett PK, Doherty CP,, A seizure care pathway in the emergency department: preliminary quality and, Epilepsy Research and Treatment, (Epub May 29 2012 ), 2012, p273175 ,
Notes: [Aim. To evaluate the utility of a seizure care pathway for seizure presentations to the emergency department (ED) in order to safely avoid unnecessary admission and to provide early diagnostic and therapeutic guidance and minimize length of stay in those admitted. Methods. 3 studies were conducted, 2 baseline audits and a 12-month intervention study and prospective data was collected over a 12-month period (Nov 2008-09). Results. Use of the Pathway resulted in a reduction in the number of epilepsy related admissions from 341 in 2004 to 276 in 2009 (P = 0.0006); a reduction in the median length of stay of those admittedfrom 4-5 days in the baseline audits to 2 days in the intervention study (P '⧠0.001); an improvement in time to diagnostic investigations such as CT brain, MRI brain and Electroencephalography (P '⧠0.001, P '⧠0.048, P '⧠0.001); a reduction in readmission rates from 45.1% to 8.9% (P '⧠0.001); and an improvement in follow-up times from a median of 16 weeks to 5 weeks (P < 0.001). From a safety perspective there were no deaths in the early discharged group after 12 months follow-up. Conclusion. The burden of seizure related admissions through the ED can be improved in a safe and effective manner by the provision of a seizure care pathway. ],
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Wakai A, O'Sullivan R, Staunton P, Walsh C, Hickey F, Plunkett PK, Development of key performance indicators for emergency departments in Ireland, European Journal of Emergency Medicine, 19, (ePub Feb 29 2012), 2012,
Notes: [Abstract OBJECTIVE: The objective of this study was to develop a consensus among emergency medicine (EM) specialists working in Ireland for emergency department (ED) key performance indicators (KPIs). METHODS: The method employed was a three-round electronic modified-Delphi process. An online questionnaire with 54 potential KPIs was set up for round 1 of the Delphi process. The Delphi panel consisted of all registered EM specialists in Ireland. Each indicator on the questionnaire was rated using a five-point Likert-type rating scale. Agreement was defined as at least 70% of the responders rating an indicator as 'agree' or 'strongly agree' on the rating scale. Data were analysed using standard descriptive statistics. Data were also analysed as the mean of the Likert rating with 95% confidence intervals (95% CIs). Sensitivity of the ratings was examined for robustness by bootstrapping the original sample. Statistical analyses were carried out using SPSS version 16.0. RESULTS: The response rates in rounds 1, 2 and 3 were 86, 88 and 88%, respectively. Ninety-seven potential indicators reached agreement after the three rounds. In the context of the Donabedian structure-process-outcome framework of performance indicators, 41 (42%) of the agreed indicators were structure indicators, 52 (54%) were process indicators and four (4%) were outcome indicators. Overall, the top-three highest rated indicators were: presence of a dedicated ED clinical information system (4.7; 95% CI 4.6-4.9), ED compliance with minimum design standards (4.7; 95% CI 4.5-4.8) and time from ED arrival to first ECG in suspected cardiac chest pain (4.7; 95% CI 4.5-4.9). The top-three highest rated indicators specific to clinical care of children in EDs were: time to administration of antibiotics in children with suspected bacterial meningitis (4.6; 95% CI 4.5-4.8), separate area available within EDs (seeing both adults and children) to assess children (4.4; 95% CI 4.2-4.6) and time to administration of analgesia in children with forearm fractures (4.4; 95% CI 4.2-4.7). CONCLUSION: Employing a Delphi consensus process, it was possible to reach a consensus among EM specialists in Ireland on a suite of 97 KPIs for EDs.],
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Plunkett PK, Byrne DG, Breslin T, Bennett K, silke B, Increasing wait times predict increasing mortality in emergency medical admissions, European Journal of Emergency Medicine, 18, 2011,
Notes: [Abstract: Background: The actual impact of emergency department 'wait' time on hospital mortality in patients admitted as a medical emergency has often been debated. We have evaluated the impact of such waits on 30-day mortality, for all medical patients over a seven year period. Methods: All patients admitted as medical emergencies via the emergency department between 2002 and 2008 were studied; we looked at the impact of time to medical referral and subsequent time to a ward bed on any in-hospital death within 30 days. Significant univariate predictors of outcome, including Charlson co-morbidity and Acute Illness Severity Score, were entered into a multivariate regression model, adjusting the univariate estimates of the readmission status on mortality. Results: We studied 23,114 consecutive acute medical admissions between 2002-2008. The triage category in the Emergency Department was highly predictive of subsequent 30-day mortality ranging from 4.8% (Category 5) to 46.1% (Category 1). After adjustment for all outcome predictors, including comorbidity and illness severity, both Door to Team and Team to Ward times were independent predictors of death within 30 days with respective Odds Ratios of 1.13 (95% CI 1.07, 1.18), and 1.07 (95% CI 1.02, 1.13). Conclusion: Delay to admission can be shown to independently adversely influence mortality outcome. We recommend maximal target limits of 4 and 6 hrs for referrals and admissions respectively, based on these mortality observations.],
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F McCarthy, S De Bhaldraithe, C Rice, CG McMahon, U Geary, PK Plunkett, P Crean, R Murphy, B Foley, N Mulvihill, RA Kenny, CJ Cunningham., Resource utilization for syncope presenting to an acute hospital Emergency Department., Irish Joural of Medical Science., 179, (4), 2010, p551 - 555,
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O'Kelly FD, Teljeur C, Carter I, Plunkett PK, The impact of a GP cooperative on lower-acuity Emergency Department attendances, Emergency Medicine Journal, 27, (10), 2010, p770 - 773,
Notes: [Background: In 1998 'Dubdoc', Ireland's first out-of-hours general practice emergency service, opened in an outpatient suite in St James's Hospital with a separate entrance 300 m from the emergency department (ED). Dubdoc was established with the aim of providing an easy access out-of-hours service for ambulatory patients of those doctors supplying the service. Aim To determine whether ED attendances for patients in the lower acuity triage categories 4 and 5 have changed since the establishment of 'Dubdoc'. Methods A retrospective review of all attendances at the 'Dubdoc' service was compared with attendances at the ED for triage categories 4 and 5 of the same hospital over a 9-year period (1999-2007 inclusive) for equivalent times of day. Results ED attendances during 'Dubdoc' hours have decreased as a proportion of all attendances for triage categories 4 and 5. ED attendances for triage categories 4 and 5 fell substantially during the study period. Conclusions Although the presence of the 'Dubdoc' service has resulted in a decrease in ED attendances for triage categories 4 and 5, this is a minor proportion of the overall decrease in attendances in this group of patients.],
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