Delayed discharges and unplanned admissions from the Day Care Unit at Mater Dei Hospital, Malta

Day care units are playing an increasingly important role in healthcare provision, however they require the development of specialised resources to fulfil their role. The rate of unplanned admissions following day-case procedures is considered as one of several indicators of the quality of day-case services available.1 The aim of this study is to identify how often there are delayed discharged or unplanned admissions following day-cases at the Day Care Unit at Mater Dei Hospital (MDH), Malta. A list of patients whose discharge did not go as planned was forwarded daily to the authors by the Bed Management Unit at MDH. The medical files of these patients were then reviewed and data collected. This included demographics, type of procedure carried out and reasons for delayed discharge or unplanned admission. The study was carried out over 45 days.peer-reviewe

Spinal fractures in Malta over one year

Spinal fractures, particularly those associated with spinal cord injuries, give rise to significant morbidity and mortality.1 Early recognition and adequate management are paramount to minimalize the two. This descriptive study reviews the cases diagnosed with a vertebral fracture at the Accident and Emergency Department over a one year period including the patients’ demographic characteristics and looks into the management instituted. It also highlights the factors which may be associated with a prolonged hospital stay.peer-reviewe

General anaesthesia in acute intermittent porphyria

Acute intermittent porphyria (AIP) is caused by the deficiency of porphobilinogen deaminase, a haem synthesis enzyme, giving rise to crises characterized by abdominal pain, tachyarrythmias and psychiatric features. Anaesthesia in AIP is challenging because it has to avoid precipitating an attack. We report a case of a lady with AIP who underwent total abdominal hysterctomy whose anaesthesia was uneventful.peer-reviewe

Obstetric admissions to the Intensive Care Unit in Malta (2012-2015) : a nationwide, population-based, cohort study

Background: To the authors’ knowledge, obstetric admissions to Malta’s ICU have not been studied. Local information was needed to compare with international data. Methods: Patients were recruited retrospectively through the ICU admissions database for 2012 - 2015. Those admitted for obstetric pathology at any stage of pregnancy and up to 30 days postpartum were included in the study. Medical notes were reviewed. Data collected included demographics; obstetric history; admission diagnosis; management including surgery; length of ICU and hospital stay; and maternal and neonatal outcomes. Data was analysed using MS Excel®. Results: 42 obstetric patients were admitted to ICU over the four year period; 39 were included in the study. 0.25% of obstetric deliveries needed admission to ICU and obstetric admissions accounted for 0.87% of all ICU admissions. The commonest admission diagnosis was haemorrhage (62%), followed by hypertensive disorders of pregnancy (26%). All patients had an arterial line inserted and for 33%, this was the only intensive care intervention. 26 patients (67%) required surgery – most commonly, an emergency Lower Segment Caesarian Section (LSCS). There were no maternal deaths over this period. However, four patients miscarried their pregnancy and there were three perinatal deaths. Conclusion: The percentage of deliveries requiring ICU admission in Malta is in line with rates reported in the literature. However, obstetric patients in Malta make up a smaller percentage of all ICU admissions than published rates. The most common admission diagnosis was haemorrhage, in contrast with most studies, where admission was commonly due to hypertensive disorders of pregnancy.peer-reviewe