NHS National Services Scotland Gyle Square 1 South Gyle Crescent EDINBURGH EH12 9EB Telephone 0131 275 6000 http://www.nhsnss.org/ Minutes ISD A&E Data Quality Meeting with NHS Boards Date: Thursday 14th November 2019 Time: 10am Venue: Gyle via TC ISD Attendees: Elaine Pauline, Elizabeth Cole, Katherine McGregor, Renata Walker NHS Board Attendees: NHS Borders: Fiona Kali, Allison Roebuck, Andrea Huggan NHS Grampian: Christine Small, Greg Cook NHS Lothian: Robyn Pascoe, Paul Leonard NHS Orkney: Andrew Marwick NHS Shetland: David Kerr NHS Western Isles: Kathy Jennings, Nicola Walsh, Susan MacAulay, Doreen MacLeod ACTION 1. Welcome and Introductions Elaine welcomed all to the meeting and introductions were made 2. Items for discussion Move to weekly A&E submissions Elaine thanked everyone for the work they have put into the submissions. So far there are no major data issues. She also checked progress towards submitting the new time point data items with each board; NHS Borders Date and Time of First Diagnostics – depends when done, needs to cross match with ED data. Date and Time of Treatment start – not sure, will be a clinician decision if they can get this. Wait to cubicle is possible. Date and Time of Triage– current issue where NHS Borders have got the time seen by first doctor but this can cause an error –as soon as nurse clicks in that field it brings up triage time which can be different. They then need to backdate the time which causes an error. In AAU around 100 patients are seen before triage, which causes 25 errors on the system a day (Triage to seen time comes up as a minus). Elaine - ISD will look at the data and see how it gets on. As long as there is a time there it doesn’t matter if before the triage. NHS Grampian Previously advised in TC earlier in year that most new time points could be supplied except Date and Time of First Diagnostics. Greg advised it is not possible yet in Trak and they don’t know when the next upgrade is – maybe early next year. We will come back to this in February. NHS Lothian Elaine asked if there is a possibility for the Wait to bed available to be supplied. Lothian thought they are supplying this already. Elaine said she can’t see it in the report. Lothian will double RP check this as there might be an issue with the extract. NHS Shetland In terms of Trak, Shetland are hoping to get the automated file transferred next week. They have a small team, but hope all will work well. The new extract – will need to wait until next year as they have to wait on the Trak upgrade within NHS Grampian first. NHS Orkney Elaine asked if the Wait to bed request can still be supplied. Orkney advised they do not have that at the moment (also awaiting same upgrade as Grampian). NHS Western Isles They have just started the new submission so will touch base at the end of November. There is still some uncertainty surrounding whether St Brendan’s should be defined as an MIU or just a community hospital. They will never be able to submit anything more meaningful than numbers- patients would be transferred if anything significant. Kathy McGregor said she would chat about this issue internally with Fiona MacKenzie. Weekly MIU files Elaine asked the group about the possibility of receiving a weekly aggregate file from MIU’s, this has not been possible at present due to MIU’s still being paper based, or just an excel spreadsheet. At the moment only Ayrshire has been able to provide an aggregate weekly MIU file. Kathy is in discussion with the Scottish Government to obtain a letter to facilitate the weekly submission data for aggregate Minor Injury Units – ISD to touch base next year to see if it has helped. Due to the issues above ISD will continue to accept a monthly aggregate files from the MIU’s, but would over time like to move to a weekly file submission from the MIU’s. NHS Western Isles have a weekly extract in Topas rather than manually putting it together so the only issue is validation. NHS Lothian – no issues with submitting on a regular basis but relying on just one person. The boards can submit two weeks of data the following week if really needed, just let ISD know. Robyn to discuss with David Bonar regarding Edington weekly submission as they may have difficulties. A&E Dataset & RCEM diagnosis list NHS Fife, Tayside and Lothian are using the RCEM diagnosis codes and the SG are keen for all boards to have this implemented although not mandatory yet. Fiona MacKenzie and Jacque Kerr are having discussions to review it and produce a paper to explore what is needed. Aiming for RCEM to be rolled out to all boards in 2021. England & Wales are using ECDS so SG to review whether to adopt all of ECDS dataset or just part of it in A&E, as current diagnosis recording is not fit for purpose. Compliance with 4 hour target There are no issues with the target guidelines and the boards are happy with what they are doing. Focus items Elaine asked boards to contact her after the meeting if there are any specific data quality issues or any other issues the boards want to discuss. There was a brief discussion about a patient who left before treatment in the A&E department. The Board said they didn’t have a flow for the patient, Elaine thought it should be flow 1. Kathy KM said she could check with Helen Maitland at Scottish Government to get further clarification on this as has produced examples where flow doesn’t fit well into the definitions. Recording of dog bites The Scottish Parliamentary Committee has been asking for information on dog bites from a national perspective, as part of the Control of Dogs Act 2010. ISD have received a couple of FOI’s and Kathy asked if/how the boards record them. NHS Borders- mainly diagnosis/objects involving injuries, but not really used. Also Presenting Complaint. NHS Grampian - Presenting Complaint/ Triage assessment (free text) NHS Lothian – Free text/RCEM Diagnosis group (all wounds) NHS Shetland - Presenting Complaint/Free text NHS Western Isles- Presenting Complaint/Free text and diagnosis: bitten by mammal or insect NHS Orkney- combination of ICD10 and free text field. Date and Time of First Full Clinical Assessment and Triage query ISD sent out an email in October asking boards to confirm whether they are using the national guidelines for Date and Time of First Full Clinical Assessment and Date and Time of Triage, due to a previous issue raised. Elaine asked the group to look at the email and get back with a NHS response. Some boards were unsure if they got the email and will double check. S/B/WI 3 Data Management update Submission/data issues – discussed earlier A&E Metadata The updated template information is now on the secure ISD website which boards are free to look at. Planned changes to sites or systems Paul Leonard advised that the new Sick Kids’ Hospital in Lothian will open in the autumn of next year. They have a new location code for it so good to go with submissions when it opens. This weekend they will open a small co-located primary care service so there may be a small increase in activity as some patients will be re-directed. Submission of Episode level data ISD checked regarding progress towards MIUs submitting episode level data. NHS Borders -some MIU’s are still on paper and some services are using EMIS. It is not possible at present to roll this out to other sites. NHS Grampian –using ADASTRA and TRAK. There have been no updates from community hospitals what their plans are. EP -will leave it now and get in touch next year. Lothian, Shetland, Orkney & WI – no issues. 4. Service Access Analyst Team Update Work to include a lot more A&E information in System Watch is now complete, Take 10 data is now live. The analysts have also been working with SG to replicate the pointillist charts to take the onus off the boards to do this task. Borders advised they have never seen Take 10/System watch. Kathy to circulate a presentation and links on how to get access to it. KM 5. Any other business ISD will probably stop the aggregate weekly report from March 2020. .