Multiple and All Emergency Admissionsinterpretation Notes

Multiple and All Emergency AdmissionsInterpretation Notes

All Emergency Admissions

An emergency admission is defined as being a new continuous spell of care in hospital where the patient was admitted as an emergency.

The total number of emergency admissions is then calculated by counting the number of continuous spells in hospital within a financial year.

From December 2009, all ISD National Statistics publications for Multiple and All Emergency Admissions and Bed Days data will be based on the date of discharge rather than the date of admission. This change has been made in order to provide more accurate, relevant and complete data, particularly in relation to bed days information. Displaying the data by date of discharge means that more complete stays are included in the analysis. An emergency admission is only counted if the date of discharge associated with the spell of hospital care is with the financial years specified.

The date of discharge for a continuous spell of hospital care is derived from the last episode of the spell of treatment.

If a patient was admitted as an emergency on 1st December 2006 and discharged on or before 31st March 2007, the patient would be counted as an emergency admission for the financial year ending 31st March 2007. If a patient was admitted as an emergency on 1st March 2007 and discharged on 1st May 2007, this would count as an emergency admission for the financial year ending 31st March 2008.

Multiple Emergency Admissions

If a patient has more than one unplanned continuous spell of treatment in hospital in a year, this is defined as a multiple emergency admission for that patient.

If one patient has 2 emergency continuous spells of care in hospital in a year and another patient has 10 emergency spells of hospital care in the same year, then they would simply count as 2 patients with multiple emergency admissions.

If a patient was admitted as an emergency on 1st December 2007 and discharged on 20th December 2007, admitted again on 1st February 2008 and discharged on 15th February 2008, this patient would count as one patient with multiple emergency admissions for the financial year ending 31st March 2008.

If a patient was admitted as an emergency on 1st December 2007 and discharged on 20th December 2007, admitted again on 1st February 2008 and discharged on 15th February 2008, and then admitted on 1st March 2008 and discharged on 2nd April 2008 with no further admissions this patient would count as a patient with multiple emergency admissions (two) for the financial year ending 31st March 2008 and a single emergency admission for the financial year ending 31st March 2009.

It is important to note that since information is shown for different geographical levels of analysis (e.g. NHS Board, Local Authority and Community Health Partnership) it is likely that the data may show some inconsistencies, for example, patients who are counted in different CHPs may only be counted once for the NHS Board.

If a patient had 4 emergency admissions within NHS Lothian but 2 were in West Lothian CHP and 2 were in Midlothian CHP because the patient moved house, these would be counted as a patient with a multiple emergency admission in West Lothian CHP and a patient with a multiple emergency admission in Midlothian CHP, but only as one patient with a multiple admission for NHS Lothian.

Bed Days

Occupied bed days are used to quantify the availability and use of beds over time.These are calculated by counting the number of days between the date of admission associated with the beginning of a patient's continuous spell of treatment and the date of discharge associated with the end of the same spell of treatment.

The date of discharge must lie between 1st April and 31st March of a given financial year to calculate the number of bed days associated with emergency admissions in that year.

Only emergency admissions with a length of stay of 365 days or less are included in the bed days analysis.

If a patient was admitted on 1st June 2006 for an emergency operation for a Heart Bypass in Cardiac Surgery specialty, and transferred from that specialty to Rehabilitation Medicine on 1st July 2006, and then subsequently discharged from Rehabilitation Medicine on 31st July 2006, this would count as a single emergency admission in the year ending 31st March 2007.The total number of occupied bed days for this emergency admission would be calculated from 1st June 2006 to 31st July 2006 (60 days).

Alternatively,

If a patient was admitted on 1st March 2007 for an emergency operation for a Heart Bypass in Cardiac Surgery specialty, and transferred from that specialty to Rehabilitation Medicine on 15th March 2007, and then subsequently discharged from Rehabilitation Medicine on 1st April 2007, this would count as a single emergency admission in the year ending 31st March 2008. The total number of occupied bed days for this emergency admission would be calculated from 1st March 2007 to 1st April 2007 (30 days).

Information Layout

For multiple emergency admissions, information for all geographical breakdowns(NHS Board, Local Authority, Community Health Partnership) are now presented as separate tables within a single data file.Each table contains menus that enable the user to obtain information on numbers of patients with 1, 2 or 3+ admissions and numbers of bed days, as well as rates per 100,000 population for various age groups. Data is provided for the last 10 financial years.

Trend information for admission and bed day rates are also displayed in graphical form, broken down by each geographical area. Specific NHS Boards/Local Authorities/CHPs of interest can be compared with each other and also with Scotland.Overall Scotland trends are shown split by age group.

A similar layout is provided for all emergency admissions.

For patients aged 65 years and over, all information for both multiple and all emergency admissions is now presented in separate tables within a single data file. Each worksheet in the file contains menus that can be adjusted to show information on numbers of emergency admissions, numbers of patients with 1, 2 or 3+ admissions and numbers of bed days, as well as rates per 100,000 population for different geographical areas.Standardised incidence ratios, see below,are also provided for patients with 2 or more admissions by NHS Board, CHP and Local Authority, for the last 6 financial years.

Patients aged 65 years and over - standardisation by sex, age group and deprivation

One of the main determinants in multiple emergency admissions, other than quality of care, is patient case mix.Factors such as deprivation, age group and gender are likely to influence numbers of multiple admissions.Thus, differences in multiple admission rates between areas may be due to differences in the case mix of patients admitted.

One way of adjusting for these differences in rates is to use standardisation.Due to small numbers the method chosen for this analysis is indirect standardisation.This method has been applied to all patients aged 65 and over.

Indirect standardisation compares actual numbers of emergency admissions to expected numbers, adjusting for age, sex and deprivation.This produces a ratio which is called a standardised incidence ratio.

HEAT targets

Patients aged 65 and over

The Scottish Government developed a HEAT target which related to the number of occupied bed days for patients aged 65 and over who were admitted as an emergency. The target is defined as follows:

By 2010/11, NHS Boards will reduce the emergency inpatient bed days for people aged 65 and over, by 10% compared with 2004/05.

With regard to the data analysis for this target, the following definitions are used:

Thepublished statistics are derived from data collected on discharges from non-obstetric and non-psychiatric hospitals (SMR01) in Scotland. Data from the 3 Scottish Dental hospitals (in Dundee, EdinburghandGlasgow), and the specialties Special Care Baby Unit and Geriatric Long Stay are excluded.

The basic unit of analysis for these figures is a Continuous Inpatient Stay (CIS) in hospital. Probability matching methods have been used to link together individual SMR01 hospitals episodes for each patient, thereby creating “linked” patient stay histories.

Only emergency admissions are selected and any lengths of stay greater than 365 days have been excluded.

Age of patients has been derived at the mid point of the financial year (i.e. age on the 1st of October of the year of admission).

The data are based on year of admission. Assessment of performance in relation to this HEAT target is measured using information based on year of admission rather than year of discharge

Patients aged 75 and over

The Scottish Government developed a new HEAT target for emergency admissions to sustain focus on this important aspect of NHS performance. The amendment to this target sharpens the focus on the subgroup of patients aged 75 and over who have longer hospital stays and a higher risk of HAI, delayed discharge and institutional care outcomes.

By 2011/12, NHS Boards will reduce the number of emergency inpatient bed days for people aged 75 and over, compared with 2010/11.

With regard to the data analysis for this target, the following definitions are used:

Only stays were the patient was admitted as an emergency are included and all emergency hospital stays of any length are included.

Age of patients is calculated using the date of the emergency admission to hospital.

Beds days are specifically allocated to the year in which they took place. For example, if a patient was admitted on 1 March 2008 and discharged on 1 May 2009 a total of 31 days have been assigned to the year ending 31st March 2008, 365 days have been allocated to the year ending 31st March 2009 and 30 days have been allocated to the year ending 31st March 2010.

For any further queries regarding the analysis of emergency admissions data, please email the Secondary Care Team.