Publications by staff affiliated to Kerry General Hospital

Recent Submissions

  • Look-back Review Report

    Safety Incident Management Team (SIMT); South /South West Hospital Group (Health Service Executive (HSE), 2018-12-05)
    In September 2017 a major review of CT Scans, Ultrasounds and Chest X-Rays reported by an individual Consultant Radiologist commenced at University Hospital Kerry (UHK). This was prompted by the notification to hospital management of three Serious Reportable Events (SRE) in the category of Care Management Events where a diagnostic error was considered by the hospital's Safety Incident Management Team (SIMT) to have had a serious impact on patients through a delay in diagnosis, limiting treatment options available to them. The matter was escalated to the South/South West Hospital Group (S/SWHG) who recommended that a look-back review would be carried out. This was approved by the National Director of the Acute Hospital Division, HSE, on the 30th of August, 2017. A Group SIMT was then established, chaired by the Chief Operations Officer S/SWHG, to carry out the look-back review. Following the notification of a further Serious Incident (SI) the review was extended in October 2017 to include all images reported by the individual Consultant concerned. Therefore, the review set about auditing 46,234 images in order to identify if there was any missed pathology within the radiology reporting process; to identify if any further patients had been affected; to communicate with them in a timely and appropriate fashion, and ultimately to ensure that patients received appropriate care. The SIMT endeavoured at all times to treat patients with utmost sensitivity and honesty whilst at the same time minimising unnecessary anxiety or distress. Over the course of the look-back eleven patients were identified as having a delay in diagnosis which had an impact on their care. Four of the eleven patients have passed away over the course of the review period. The hospital and the HSE acknowledge that patients and families’ experiences were devastating for them and have had a profound and lasting effect on both the patients affected and their families. The South/South West Hospital Group, University Hospital Kerry and the Health Service Executive (HSE) would like to apologise sincerely and unreservedly to all patients and families harmed by delayed diagnoses.
  • DVD Versus Physiotherapist-Led Inhaler Education: A Randomised Controlled Trial.

    Khan, R; Yasin, F; O'Neill, S; Cahalane, E; O'Shea, R; Browne, B; Cournane, J; Rand, S; Shannon, H (2018-02-09)
    Correct technique with inhalers is vital for therapeutic effect. Efficacy of DVD inhaler instruction was investigated. Secondary aims were to examine feasibility of an inhaler technique outcome measure, and to compare knowledge and self-efficacy after DVD or individual education. This was a randomised controlled trial conducted in a regional hospital paediatric ward, involving new or existing paediatric inhaler users. Inhaler technique was assessed pre-education in existing inhaler users. Participants were then randomised to message equivalent education by DVD or individually with a physiotherapist. Inhaler technique, self-efficacy and knowledge were assessed immediately post- and three months after education. Twenty one participants received DVD or individual education. There were no significant differences between groups for technique, self-efficacy or knowledge at any time. The outcome measure was feasible for use in a research study. DVD education was equivalent to individual instruction to teach parents how to use inhalers with their child.
  • Absorbable Polydioxanone (PDS) suture provides fewer wound complications than polyester (ethibond) suture in acute Tendo-Achilles rupture repair

    Baig, M N; J G Galbraith, J G; Yousaf, I; Din, Robert (Irish Medical Journal, 2017-05)
    We prospectively studied acute Achilles tendon rupture in patients over a two 2-year period and reviewed the causes, outcome and complications. There were 53 patients included with acute Achilles rupture with minimum follow up period of 6 months. We compared the outcomes including infection rate and Boyden score between the two groups repaired by Polydioxanone and Polyester respectively. All infected cases had a suture repair using the polyester suture. The difference in the infection rate was highly significant between the 2 groups (p=0.001). All 34 patients (100%) in the PDS group had good / excellent results based on the Boyden clinical assessment. Conversely, only 16 patients 9(68.4%) had good or excellent results IN Polyester repair group. Patients treated with a non- absorbable suture (ethibond) material for repair had a higher incidence infection and worse Boyden scores than the absorbable PDS group.
  • AMAU Patient and Carer Satisfaction Survey

    Rathore, F; Sultan, N; Byrne, D (Irish Medical Journal, 2015-06)
    We present a Survey conducted to assess Patients and their Carer's AMAU Experience, at Kerry General Hospital, this survey is first of its kind to be carried out in the country. AMAU is the gateway to the hospital for acutely ill medical patients. A patient’s stay in the unit is limited, usually around 6 hours. The National Acute Medical Programme has set standards for the workings of an AMAU across the country to ensure high quality standardized care to the satisfaction of the patients in particular and public in general. We conducted a survey to study the satisfaction with the service provided at KGH, A pre-set questionnaire from the National Acute Medical Programme was handed to 50 consecutive patients and 50 Carers, at the end of AMAU visit. Each questionnaire consisted of questions, which addressed various aspects from triage to discharge, including promptness of access, the availability of information, cleanliness and facilities, medical and nursing care and overall experience, the participants chose between Excellent, Good, Fair, Poor, for each question that best described their judgement.
  • Medical students views on selection tools for Medical School - a mixed methods study

    Stevens, L; Kelly, ME; Hennessy, M; Last, J; Dunne, F; O’Flynn, S (Irish Medical Journal (IMJ), 2014-09)
    It is important to ensure that the tools used in Medical School selection are acceptable to students and applicants. A questionnaire was administered to year 1 medical students in 2010 to determine the suitability of a variety of selection tools and the acceptability of HPAT-Ireland in particular. There were 291 respondents a 77% response rate representing approximately one third of all school leaver entrants that year. While the majority 285( 98%) were in favour of using school leaving examinations there was also support for the use of interviews 215 (74%) and other tools. Three quarters of Irish respondents 159 (76%) agreed that HPAT-Ireland is a fair test overall however section 3 (non-verbal reasoning) appeared lees acceptable and relevant than other sections. A little over half had taken a preparatory HPAT -Ireland course 112 (54%).
  • Tolerance of colonoscopy and questioning its utility in the elderly population

    Rathore, F; Sultan, N; Byrne, D (Irish Medical Journal, 2014-09)
    This study was carried out from Jan ’12-Dec ’12 to assess current practice in Kerry General Hospital against the age related indicators for colonoscopies. A total of 1474 colonoscopies were performed,1177 (79.9%) were diagnostic and 297 (20.1%) were therapeutic, patients were divided into 4 age groups under 75, 75-80, 81-85, 86+. The trend analysis revealed an increase in diagnostic colonoscopies and decrease in therapeutic colonoscopies with age. 664 (45.04%) of colonoscopies were reported normal which made up the majority of the total diagnoses, 1330 (90.2%) of colonoscopies occurred without any complications. Main complications were patient discomfort being the highest, present in 112 (7.6%) of patients, and lowest being urticaria around the IV site present in 1 (0.1%) of the cases. Patient discomfort was higher in younger patients as evidenced by 98 cases aged <75, followed by 11 cases aged 75-80, 2 cases aged 81-85 and 1 case aged >86. Highest percentage of poor tolerance was found in 14 (1.1%) of total patients <75, 1 (0.8%) of total patients aged 75-80, 1(1.7%) of total patients in age group 81-85 and none (0%) in age group >86. We have established the safety of colonoscopy, low rate of complications and a better tolerance in the elderly from this study, however, its utility, especially in presence of other comorbidities in elderly is questionable.
  • The burden of cost- admission versus discharge medications

    Akintola, A; Youssef, M; Oh, S; Byrne, D; Liston, R (Irish Medical Journal, 2014-06)
    Sir, Avoiding unnecessary polypharmacy prevents potential drug-drug interactions culminating in adverse drug events. 1 Medication review is an important opportunity for rationalizing a patientâ s treatment to maximize therapy for established chronic disease and minimize the potential for drug-drug and drug-disease interaction. A secondary consideration is the potential for a drug review to identify the possibility of cost saving by noting those occasions where generic substitution could occur without detriment to the patients overall therapy. We completed an audit of drug costs of medications for patients on admission and on discharge from an acute general hospital. The charts of the first 94 medical patients admitted into an acute general hospital starting from January 1st 2012 were sourced from Hospital In-Patient Enquiry (HIPE) and a pre-designed questionnaire was completed for each of these patients. The cost of medications per patient was calculated using the MIMMS manual appropriate for the period of admission and discharge. We examined the patient demographics, source of referral, LOS (length of stay), admission diagnosis, past medical history and names of medications and their individual costs.
  • Family planning and inflammatory bowel disease: the patient and the practitioner.

    Toomey, Desmond; Waldron, Brian; Department of Surgery, Kerry General Hospital Tralee, Co Kerry, Ireland. (2013-02)
    Patients with inflammatory bowel disease (IBD) are commonly in their child-bearing years. Maintainance medication, as recommended by international guidelines, is an emotive topic and an anxiety source. This study measures the awareness of patients and primary practitioners of the issues involved.
  • Avascular necrosis of bilateral femoral heads in a patient with Fabry's disease.

    O'Neill, Francis; Rice, John; Trauma and Orthopaedic Department, Kerry General Hospital, Tralee, Kerry, Ireland. (2012-07-13)
    The underlying cause of avascular necrosis (AVN) of the femoral head is often not apparent. We report the case of a 26 year old builder with a four month history of bilateral hip pain, and a diagnosis of bilateral femoral head avascular necrosis. Fabry's disease was identified as the probable cause. Since 2001, enzyme replacement therapy for Fabry's disease has become available, with a potential to influence the disease process, and this is of potential importance to clinicians treating AVN.
  • Severe hemorrhage from a hypodermoclysis site.

    O'Hanlon, Shane; Sheahan, Patricia; McEneaney, Robert; Kerry General Hospital, Tralee, Co Kerry, Ireland. (2012-01-31)
    Hypodermoclysis, or subcutaneous infusion of fluids, is an alternative means of administration of fluid. It is sometimes used in older patients in whom there is difficulty achieving intravenous access, or who are entering the terminal stage. It is considered a relatively low-risk procedure. We report a case where a patient's death may have resulted from its use.
  • Education in geriatric medicine for community hospital staff.

    O'Hanlon, Shane; Liston, Richard; Kerry General Hospital, Ireland. (2010-12)
    Community hospitals provide many services for older people. They are mainly managed by nursing staff, with some specialist input. Little is known about education provided in these facilities. Most education in geriatric medicine is provided in hospitals, despite most elderly care being provided in the community. The authors surveyed senior nursing staff in Irish community hospitals to examine this area in more detail. Staff in all 18hospitals in the Health Service Executive (South) area were invited to participate. The response rate was 100%. Sixteen of the 18 respondents (89%) felt staff did not have enough education in geriatric medicine. Just over half of hospitals had regular staff education sessions in the area, with a minority of sessions led by a geriatrician, and none by GPs. Geriatrician visits were valued, but were requested only every 1-3 months. Staff identified challenging behaviour and dementia care as the areas that posed most difficulty.
  • Do we need community geriatrics?

    O'Hanlon, S; Liston, R; Kerry General Hospital, Tralee, Co Kerry. (2012-01-30)
    Community geriatrics has evolved as a specific aspect of geriatric medicine in the UK. In Ireland there is uncertainty as to how it should be planned. This is the first national survey of consultants, specialist registrars and general practitioners to seek their opinions. Most consultants and GPs reported already having a community aspect to their current practice, e.g. nursing home visits or community hospital visits, whereas most SpRs did not. Forty three of 62 respondents (69%) agreed that there is a need for community geriatricians and that there should be integration with hospital medicine. Fifty seven of 62 respondents (92%) felt that there would be a beneficial effect on GP services, though some expressed concern about work overlap. Thirteen of the 25 SpRs (52%) in training hoped to begin practice in community geriatrics in the future.
  • Refocusing acute psychiatry, performance management, standards and accountability, a new context for mental health nursing.

    Harnett, P J; Bowles, N; Coughlan, A; Kerry Community Services, Kerry General Hospital, Rathass, Tralee, Co. Kerry, Ireland. (2009-06)
    The term 'performance management' has an aversive 'managerial' aspect, is unappealing to many public sector staff and has an 'image problem'. Perhaps as a consequence, it has failed to make a significant impact on Irish public sector workers, notably mental health nurses. In this paper, performance management is introduced and examined within an Irish healthcare context and with reference to its use in other countries. Some of the challenges faced by Irish mental health nurses and the potential benefits of working within a performance managed workplace are discussed. The paper concludes that performance management is likely to increasingly affect nurses, either as active agents or as passive recipients of a change that is thrust on them. The authors anticipate that the performance management 'image problem' will give way to recognition that this is a fundamental change which has the potential to enable health services to change. This change will bring high standards of transparency, worker involvement in decision making, an explicit value base for health services and individual teams. It provides the potential for clear practice standards and high standards of transparency as well as worker welfare in all aspects, including supporting employment and career progression.
  • Gastric cancer-related information on the Internet: incomplete, poorly accessible, and overly commercial.

    Killeen, Shane; Hennessey, Arthur; El Hassan, Yahear; Killeen, Kelvin; Clarke, Nick; Murray, Kevin; Waldron, Brian; Department of Surgery, Kerry General Hospital, Tralee, Co. Kerry, Ireland. (2011-02)
    Patients increasingly use the Internet for gastric cancer information. However, the quality of the information is questionable. We evaluated the accuracy, completeness, accessibility, reliability, and readability of gastric cancer websites.
  • Acute medical units: review of evidence.

    Byrne, Declan; Silke, Bernard; Department of Medicine, Kerry General Hospital, Tralee, Ireland. (2011-08)