Discharges from NHS Hospitals to Care Homes between 1 March and 31 May 2020 Validated register of hospital discharges to care homes methodology Publication date: 28 October 2020 Revised 21 April 2021 A Management Information release for Scotland Public Health Scotland This is a Management Information publication Published management information are non-official statistics which may be in the process of being transitioned into official statistics. They may not comply with the UK Statistics Authority’s Code of Practice with regard to high data quality or high public value but there is a public interest or a specific interest by a specialist user group in accessing these statistics as there are no associated official statistics available. Users should therefore be aware of the aspects of data quality and caveats surrounding these data, all of which are listed in this document. Find out more about Management Information publications at: https://code.statisticsauthority.gov.uk/national-statisticians-guidance-management-information- and-official-statistics-3/ 1 Public Health Scotland Contents Revisions ................................................................................................................................. 4 Introduction .............................................................................................................................. 5 Identifying People Discharged to a Care Home ........................................................................... 5 Section 1 – Discharges from NHSScotland Hospitals to care homes ...................................... 6 Overview – creating the register of discharges to care homes ................................................ 6 Datasets used to identify hospital discharges ........................................................................ 10 SMR01/SMR01E – acute & geriatric long stay activity ............................................................... 10 SMR04 – Psychiatric inpatient activity ....................................................................................... 11 RAPID - Rapid Preliminary Inpatient Data (RAPID) ................................................................... 11 Linking hospital activity datasets together ............................................................................. 12 Additional Datasets used to identify care home residents ..................................................... 13 Delayed Discharges ................................................................................................................... 14 Scottish Ambulance Service (SAS) Patient Transport Service (PTS) ........................................ 14 National Records Scotland (NRS) Deaths ................................................................................. 14 CHI Institution Flag ..................................................................................................................... 15 Health and Social Care Partnership Temporary Care Home Residents ..................................... 15 Adding care home flags to hospital dataset ........................................................................... 16 Delayed discharges Flag ........................................................................................................ 16 Scottish Ambulance Service patient transfer service data flag ............................................... 16 Health & Social Care Partnerships temporary care home information flag ............................. 16 Summary of care home flags .................................................................................................. 17 Quality assurance of discharges register ............................................................................... 17 Adding records into the dataset .................................................................................................. 17 Removing records from the dataset ........................................................................................... 18 Specific data quality issues identified and resolved ................................................................... 18 Conclusions ................................................................................................................................ 19 Revisions ................................................................................................................................ 19 Defining COVID-19 status of individuals ................................................................................ 21 Electronic Communication of Surveillance in Scotland (ECOSS) ............................................... 21 Linking testing and discharges dataset ...................................................................................... 21 Section 2 – Impact on care homes ........................................................................................ 23 2 Public Health Scotland Care home data sources ....................................................................................................... 23 Allocation of care home of discharge ......................................................................................... 23 Unique Property Reference Number (UPRN)............................................................................. 25 Care home service data ............................................................................................................. 25 Relationship between care home size and discharges .............................................................. 27 Section 3 – Additional analysis including Genomic Sequencing ............................................ 30 How individual discharges were assigned pre-hospital residency .............................................. 30 Glossary ................................................................................................................................ 32 Contact .................................................................................................................................. 34 Further Information ................................................................................................................ 34 Rate this publication .............................................................................................................. 34 Appendices ............................................................................................................................ 35 Appendix 1 – Comparison of Hospitals in SMR01 and RAPID ................................................... 35 Hospitals in SMR01 not in RAPID .......................................................................................... 35 Hospitals in RAPID not in SMR01 .......................................................................................... 37 Appendix 2 – References ........................................................................................................... 39 Appendix 3 – Publication Metadata ............................................................................................ 40 Appendix 4 – Early access details .............................................................................................. 42 Appendix 5 – PHS and Official Statistics .................................................................................... 42 3 Public Health Scotland Revisions This report is a revised version of the previous “Hospital Discharges into Care Homes in Scotland” published on 28 October 2020. The following revisions have taken place: • Further quality assurance of the data used in this report, which has resulted in 6 discharges (3 individuals) being removed from the analysis. This is because these discharges were later identified as not being to a care home. All statistics, tables and charts have been updated in the report to reflect this change. This means there are now 5,198 discharges in the underlying data-set, rather than 5,204 previously. This does not impact on the main conclusions from the original report. • The statistical modelling part of section 2 (which analyses the risk of care home outbreaks associated with hospital discharge) has been updated following feedback from users and the Office for Statistics Regulation. We have included additional visuals and commentary relating to the interpretation of the results to provide greater clarity on our findings. • Section 3 has been added. Since the publication of the original report in October 2020, further analysis has been performed to explore specific aspects in detail including: • classification of discharges based on pre-hospital residency (where people lived before they were admitted to hospital); • analysis of the outcomes within 30 days of hospital discharge (all-cause mortality, COVID-19 mortality and COVID-19 infection) of all those who were discharged; • and analysis of those individuals whose last positive test before discharge was positive (including relationship with care home outbreaks). • Collaboration with the Public Health Microbiology Team within Public Health Scotland enabling the clinical data on people whose last positive test before discharge was positive to be combined with viral genomic sequencing data (where available). The genomic data has allowed analysis of the specific samples of those discharged from hospital and the samples from the care home they were discharged-to, to be compared to understand more about patterns of infection transmission and relationships between hospital