Pat Rohan1, Conor Casey2, Gregory J Nason3, Jan Sorensen4, Kenneth Mealy5,6. 1. Department of Surgery, Wexford General Hospital, Wexford, Ireland. Pat.rohan@ucdconnect.ie. 2. Department of Surgery, Blackrock Clinic, Dublin, Ireland. 3. Division of Urology, Toronto General Hospital, Toronto, ON, Canada. 4. Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland. 5. Department of Surgery, Wexford General Hospital, Wexford, Ireland. 6. Royal College of Surgeons in Ireland, 123 St. Stephens Green, Dublin, Ireland.
Abstract
BACKGROUND: Urolithiasis is a common urological presentation1. A total of 25-49 million people in Europe live with symptomatic stone disease, with the incidence increasing1. AIMS: To examine length of stay (LOS) and transfer patterns for patients presenting with urolithiasis to Irish Model 2/3 hospitals without a specialist urology service, compared with those who present to a model 4 hospital with an on-site urology service. METHODS: Using the National Quality Assurance & Improvement System (NQAIS), we assessed patients presenting with urolithiasis, nationally from January 2016 to December 2019. RESULTS: During the study period, there were 11,856 emergency presentations with urolithiasis. A total of 6510 (54.9%) presented to model 4 hospitals, while 5346 (45.1%) presented to model 2/3 hospitals. A total of 874 (16.35%) patients required transfer from model 2/3 hospital to a model 4 hospital for further management. Those transferred from model 2/3 hospitals spent a mean of 3.68 days awaiting transfer and had a mean LOS of 3.88 days in the model 4 hospital. A total of 7.56 days compared with a mean LOS of 2.9 days for those presenting directly to a model 4 hospital. CONCLUSION: At a national level in Ireland, many patients with urolithiasis present to hospitals that are unable to cater for their needs. Patients presenting with urolithiasis to model 2/3 hospitals have significantly longer LOS compared with patients who present directly to a model 4 hospital. A formal 'stone pathway' is required to provide timely care for these patients2-such a pathway would provide better patient care and result in improved bed utilisation.
BACKGROUND: Urolithiasis is a common urological presentation1. A total of 25-49 million people in Europe live with symptomatic stone disease, with the incidence increasing1. AIMS: To examine length of stay (LOS) and transfer patterns for patients presenting with urolithiasis to Irish Model 2/3 hospitals without a specialist urology service, compared with those who present to a model 4 hospital with an on-site urology service. METHODS: Using the National Quality Assurance & Improvement System (NQAIS), we assessed patients presenting with urolithiasis, nationally from January 2016 to December 2019. RESULTS: During the study period, there were 11,856 emergency presentations with urolithiasis. A total of 6510 (54.9%) presented to model 4 hospitals, while 5346 (45.1%) presented to model 2/3 hospitals. A total of 874 (16.35%) patients required transfer from model 2/3 hospital to a model 4 hospital for further management. Those transferred from model 2/3 hospitals spent a mean of 3.68 days awaiting transfer and had a mean LOS of 3.88 days in the model 4 hospital. A total of 7.56 days compared with a mean LOS of 2.9 days for those presenting directly to a model 4 hospital. CONCLUSION: At a national level in Ireland, many patients with urolithiasis present to hospitals that are unable to cater for their needs. Patients presenting with urolithiasis to model 2/3 hospitals have significantly longer LOS compared with patients who present directly to a model 4 hospital. A formal 'stone pathway' is required to provide timely care for these patients2-such a pathway would provide better patient care and result in improved bed utilisation.
Authors: Patrick Michael; Vi T Tran; Marilyn Hopkins; Ian Berger; Justin Ziemba; Utsav K Bansal; Adithya Balasubramanian; Jessie Chen; Wesley Mayer; Andrew Fang; Soroush Rais-Bahrami; Andrew James; Andrew Harris Journal: Urology Date: 2019-11-18 Impact factor: 2.649
Authors: Noah E Canvasser; Peter Alken; Michael Lipkin; Stephen Y Nakada; Hiren S Sodha; Abdulkadir Tepeler; Yair Lotan Journal: World J Urol Date: 2017-01-20 Impact factor: 4.226
Authors: Kristy Kummerow Broman; Rachel M Hayes; Sunil Kripalani; Eduard E Vasilevskis; Sharon E Phillips; Jesse M Ehrenfeld; Michael D Holzman; Kenneth W Sharp; Richard A Pierce; William H Nealon; Benjamin K Poulose Journal: Am J Surg Date: 2016-06-01 Impact factor: 2.565
Authors: Eric I Benchimol; Liam Smeeth; Astrid Guttmann; Katie Harron; David Moher; Irene Petersen; Henrik T Sørensen; Erik von Elm; Sinéad M Langan Journal: PLoS Med Date: 2015-10-06 Impact factor: 11.069
Authors: Deirdre M Nally; Jan Sørensen; Gintare Valentelyte; Laura Hammond; Deborah McNamara; Dara O Kavanagh; Ken Mealy Journal: BMJ Open Date: 2019-11-02 Impact factor: 2.692