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Consultation on the Proposed New Accident & Emergency Publication The following document outlines the proposed changes to the Accident & Emergency (A&E) quarterly publication. This consultation will be for the period 7th September to 19th October 2012. The aim is to allow as many stakeholders as possible to comment or contribute towards the proposals. The main reasons for carrying out these changes are to develop the usability of the output and improve the clarity of A&E information. There are several key notes about A&E data that impact on how they are reported and presented which will be included in future reports. These include information on the type of data being collected, type of attendance recorded, and the type of site. Type of Data There are two types of data submitted to the A&E data mart; episode level and aggregate level data. The larger hospitals generally submit episode level data containing a detailed record for each attendance. Some smaller sites only submit aggregated data as they do not have the information systems and support to enable collection of detailed patient based information. The aggregated data consists of total monthly attendances with figures for any breaches to the 4 hour standard. The majority of the publication focuses on episode level information. <Statistics on the latest ratio of episode level data to aggregate data to be inserted here> Type of Attendance Accident & Emergency data are made up of four types of attendances – new, unplanned returns, planned returns, and recalls. Only sites that provide episode level data can distinguish between these categories. A new attendance is the first or only attendance; a return attendance is a repeat visit to the same department for the same incident/condition as the first visit (planned - where a patient is given an appointment to return, unplanned - where a patient returns unexpectedly in connection with the original complaint); a recall attendance is when the patient is asked to return to the department (due to unexpected test results for example).This publication only reports on new and unplanned returns in keeping with national policy. Only around 1.4% of attendances are planned returns or recalls. Type of Site Under current publications, sites are split into two groups: Emergency Departments (ED) - sites that provide a 24 hour, consultant in emergency medicine led service Minor Injuries Unit (MIU) / other - small hospitals and health centres in rural areas that carry out emergency care activity and are GP or Nurse led. They may or may not be open 24 hours. There is the potential to split the type of site differently in future, given that some MIU sites have a substantial number of attendances. The proposal is to split sites into: Emergency Departments (ED) Minor Injuries Unit (MIU) – over a certain size (to be defined by the consultation – ISD would welcome suggestions on this) Remaining Sites The majority of Emergency Departments and some Minor Injuries Units are included in the T10 HEAT target. This is a target to reduce attendances. A list of sites included in the T10 HEAT target is on the website. Proposed Documents The proposal is to split the publication into four sections, plus an overall report. Each section will be presented in a separate Excel spreadsheet. In each spreadsheet there will be a number of tabs including contents and relevant notes, details on all sites, and various graphs and tables relating to the topic area. They are: (1) Attendance Trends & Rates – looking at overall attendances and breaches with some data at aggregate level. (2) Referrals, Arrival Modes & Breach Reasons – looking at the percentage breakdowns of where patients have been referred from, how did they get to A&E, and reasons for time spent in the department exceeding the 4 hour standard. This is only on sites that provide episode level data. (3) Compliance & Comparison – looking at the performance over the last four months against the 4 hour standard, the change in attendance rates, length of time in the department, time to first assessment, and time of arrivals. This is only on sites that provide episode level data (4) T10 HEAT Target to Reduce Attendances – this only contains data on those sites that are part of the T10 HEAT target. It looks at the current trend, a 12 month moving average, and trajectory to meet the target. There is also comparison of attendance rates (5) Report – this will be determined by the contents and layout of the published tables and graphs. Essentially it will be broken down the same way as above, providing graphical information alongside some commentary and background information. There will be links from the report to the data documents for further breakdowns and graphs. Contribution Further detail on each section is given below, as well as proposed data breakdowns. If you have any questions or comments about the proposal please contact: [email protected] Consider - Does this provide the information that you would find useful - The breakdowns, specifically around the site type i.e. MIU over a certain size - Are there additional things you would like to see, and why? - Are there things you would not like to see included, and why? (1) – Attendance Trends & Rates Tab 1 – Contents & Notes This will provide all general notes and caveats about the data, as well as specific points about the breakdowns contained within this document. Tab 2 – Trend & 4 Hour Compliance (Episode & aggregate sites) Graph - Number trend (monthly totals) - 4 hour compliance % - 4 hour standard % Table - Number trend - 4 hour breaches % Data by - NHS Board & hospital Frequency - Monthly Tab 3 – Ave Daily Trend, 4 Hour Compliance & 12 Hour Breaches (Episode only) Graph - Average daily attendance trend - 4 hour compliance % - Ave 4 hour compliance % - 4 hour standard % - 12 hour breaches Table - Average daily attendance trend - 4 hour breaches % - 12 hour breach numbers Data by - NHS Board & hospital Frequency - Monthly Tab 4 – Trend of Attendance & Admission Rates (Episode only) Graph - Attendance rate trend - Admission rate trend Table - Attendance rates - Admission rates Data by - NHS Board, site type, attendance type, age/gender Frequency - Monthly Tab 5 – List of Sites Detail - ED or MIU / Other - Episode or aggregate data sent in - Any changes to site - Completeness of CHI (Community Health Index number) - Any specific data issues with the site (2) – Referrals, Arrival Modes & Breach Reasons (Episode level only) Tab 1 – Contents & Notes This will provide all general notes and caveats about the data, as well as specific points about the breakdowns contained within this document. Tab 2 - Referrals Graph - Breakdown of referral types % Table - Numbers of each referral type Data by - NHS Board, site type, attendance type, age/gender Frequency - Quarterly Tab 3 – Mode of Arrival Graph - Breakdown of arrival mode types % Table - Numbers of each arrival mode type Data by - NHS Board, site type, attendance type, age/gender Frequency - Quarterly Tab 4 – Breach Reasons (4 Hours) Graph - Breakdown of reason types % Table - Numbers of each reason type Data by - NHS Board, site type, attendance type Frequency - Quarterly Tab 5 – Breach Reasons (12 Hours) Graph - Breakdown of reason types % Table - Numbers of each reason type Data by - NHS Board, site type, attendance type Frequency - Quarterly Tab 6 – List of Sites Detail - ED or MIU / Other - Episode or aggregate data sent in - Any changes to site - Completeness of CHI (Community Health Index number) - Any specific data issues with the site (3) – Compliance & Comparison (Episode level only) Tab 1 – Contents & Notes This will provide all general notes and caveats about the data, as well as specific points about the breakdowns contained within this document. Tab 2 – 4 Hour Compliance Comparison Chart Graph - 4 hour compliance % (bouncing ball) Table - Trend of 4 hour compliance Data by - NHS Board, attendance type, site type Frequency - Last four months Tab 3 – Attendance Rates Comparison Chart Graph - Rates of attendance (bouncing ball) Table - Trend of rates Data by - NHS Board, attendance type, site type Frequency - Last four months Tab 4 – Length of Time in Department Graph - Numbers & length of time Table - Numbers <4 hours, 4 hours to 12 hours, >12 hours Data by - NHS Board & hospital, attendance type Frequency - Quarterly Tab 5 – Time from Arrival to 1st Assessment Graph - Numbers & length of time Table - Numbers <4 hours, 4 hours to 12 hours, >12 hours Data by - NHS Board & hospital, attendance type Frequency - Quarterly Tab 6 – Time of Arrival Graph - Numbers & length of time Table - Numbers <4 hours, 4 hours to 12 hours, >12 hours Data by - NHS Board & hospital, attendance type Frequency - Quarterly Tab 7 – List of Sites Detail - ED or MIU / Other - Episode or aggregate data sent in - Any changes to site - Completeness of Community Health Index number (CHI) - Any specific data issues with the site (4) T10 HEAT Target to Reduce Attendances (T10 Sites only – see list on website) Tab 1 – Contents & Notes This will provide all general notes and caveats about the data, as well as specific points about the breakdowns contained within this document. Tab 2 – HEAT Site Trend Graph - Attendance numbers for selected options Table - Attendance numbers for all boards & Scotland Data by - NHS board, attendance type Frequency - Monthly Can compare three Boards (incl. Scotland) at once Tab 3 – HEAT Site Trend & Trajectory Graph - Attendance trend - 12 month average - Trajectory Table - Trend of 4 hour
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