Support Accident and Emergency Indicators

Guidance on Producing Reports

QP12 to QP14

Guidance on Producing Reports to Support Accident and Emergency indicators QP12 to QP14

1. Introduction

The accident and emergency (A&E) indicators have been introduced for one year from April 2012 and are aimed at reducing avoidable A&E attendances. A&E attendances indicators (QP12 and QP13) require that a practice undertake an internal review followed by an external peer review. To assist this process ISD Scotland at the request of the Scottish Government, have created 4 standard reports which are available via the national A&E and SPARRA datamarts and can be accessed and run by NHS Board staff (subject to appropriate authorisation see Appendix 1).

This paper provides details, the data definitions for the indicators and how to access the data. It is envisaged that each NHS Board will run the reports for GP Practices to work through from the national A&E and SPARRA datamarts. It is a local NHS Board decision (likely the Primary Care leads) on how to disseminate the reports to GP Practices and local confidentiality guidelines should be followed. A diagram in Appendix 2 lists the data flow from collection to sending the lists of patients to the GP Practice. Upon request ISD can provide the name of NHS Board staff that have access to the datamart and can therefore run these reports for each NHS Board.

2. Background - Emergency Departments and A&E services.

Currently across Scotland there are 96 departments that provide an A&E type service. This ranges from 24 hour Emergency Medicine Consultant led departments to GP led, Nurse led, minor injury departments that may or may not be open 24 hours.

Of the 96 departments, 48 submit patient level data to ISD by the 10th of each month all of the previous calendar months attendances e.g. all May 2012 attendances are submitted by the 10th June. All Emergency Departments in Scotlandi.e. Emergency Medicine consultant led departments, provide patient level data. The remaining departments do not have IT solutions in place and therefore, only provide a count of their attendances and compliance with the 4 hour wait standard. Appendix 3 lists all the departments across Scotland, their number of attendances for October to December 2011 and whether they supply patient level data or not.

3. Reports Available

General

the 4standard reports are based only on A&E sites that submit patient level data to ISD (See Appendix 3).
only new and unplanned attendances are included i.e. patients who are asked to come back to the A&E service for review are not included the reports.

Sites to include

In Scotland, the principle of focusing on Type 1 A&E’s(i.e. 24 hour emergency medicine consultant led departments) where appropriate and thereafter on the most frequently used local urgent care service should be applied.

For Rural Health Boards where the National QOF QP Framework may not easily apply, local flexibility should apply and where appropriate should be agreed between the Health Board and the LMC. Where agreement between the Health Board and the LMC is not reached, for whatever reason, then the Scottish Government Health Department and Scottish GPC will decide jointly The Scottish Government will support individual boards to identify areas of action where there are no relevant A&E attendances

Appendix 3 lists the sites and number of attendances for the last quarter of 2011 to assist these discussions.

Report 1 - <16‘s attending A&E with a minor injury/illness

All <16’s who have presented at an A&E department and upon discharge/transfer from the department are recorded as minor i.e. do not require to be transferred to an assessment unit or admitted to hospital.

Access this report via the A&E datamart – Public Folders/Scotland/NHS/A&E2/Standard Reports/(03) Management Reports/Under 16 Minor Attendences
All <16’s (age derived from CHI) who have presented at A&E and upon discharge/transfer have a ‘patient flow’ of 1 or 5.
Flow 1 – Minor Injury and Illness, including care provided in A&E Departments, in Minor Injury Units and through schemes such as Paramedic See and Treat.
Flow 5 – Out-of-Hospital Care, this flow will support the development of alternatives to hospital attendance and admission, reducing waits and delays for patients who need urgent hospital assessment and treatment, and facilitating timely discharge for those who are ready for discharge from hospital. Involvement of partners in community care will be essential to delivery of significant change
When the report runs you will be prompted to enter the start and end dates of the period you wish to look at.

Report 2 - Frequent attenders

In Scotland adult frequent attenders at Emergency Departments (ED) are defined as patients age 16 and over who attend any Emergency Department 10 or more times within a year or attend 5 or more times within a 3 month period.Further details can be found in Appendix 4 or on the ISD website

Access this report via the A&E datamart – AE2: Multiple Attends (16+)
Please read the notes attached to this report. To run the report click on the Refresh button in the top right hand corner of the screen.

Report 3 – Men of working age with minor attendances

All male patients 18 years and over who have presented at an A&E department and upon discharge/transfer from the department are recorded as minor i.e. do not require to be transferred to an assessment unit or admitted to hospital.

Access this report via the A&E datamart – Public Folders/Scotland/NHS/A&E2/Standard Reports/(03) Management Reports/AE2: Men of Working Age with Minor Attendances
All males18 years and older (age derived from CHI) who have presented at A&E and upon discharge/transfer have a ‘patient flow’ of 1 or 5.
Flow 1 – Minor Injury and Illness, including care provided in A&E Departments, in Minor Injury Units and through schemes such as Paramedic See and Treat.
Flow 5 – Out-of-Hospital Care, this flow will support the development of alternatives to hospital attendance and admission, reducing waits and delays for patients who need urgent hospital assessment and treatment, and facilitating timely discharge for those who are ready for discharge from hospital. Involvement of partners in community care will be essential to delivery of significant change
When the report runs you will be prompted to enter the start and end dates of the period you wish to look at.

Report 4 - SPARRA

Patients aged 65 plus who have attended A&E at least once in the past year and who have a SPARRA risk score of 50% and above.

Access the report ‘SPARRA – QOF QP A&E attendances’ via the Standard Reports folder in the SPARRA datamart
Reply to the CHP and Practice Code prompts (the default is All CHPs/Practices) and run the query.
The report returns patient level data ordered by Practice Code and CHI number.

4. Overall picture of attendances at A&E by GP practice - Navigator

Since March 2012 aggregate information is available at NHS Board, CHP and GP Practice level on A&E attendances. Comparative information is shown for the number of A&E attendances, age-sex standardised attendance rates, the % minor injuries/illnesses, the % admitted and the time/day of attendance. This information can be used as part of the comparative information provided to GPs

Navigator is a web-based information tool designed to meet the needs of key healthcare staff in NHS Boards, Community Health Partnerships (CHPs) and hospitals. Navigator provides user-friendly access to a broad range of comparative information to help review, monitor and plan healthcare services and support quality improvement. If you are interested in obtaining access to Navigator please contact .

Appendix 1 – Access to National Datamarts

Currently to access the national datamarts approval must be granted on an individual basis by the Caldicott Guardian in each NHS Board and an authorised signatory at ISD.

A&E

Scottish Health Information Service support the development and release of a range of data marts as part of its remit to enable secure online access to nationally held data. Guidance is provided here on how to access the A&E datamart

SPARRA

Scottish Patients at Risk of Readmission and Admission (SPARRA) is an algorithm developed by Information Services Division (ISD) to predict a patient's risk of being admitted to hospital as an emergency in a particular year. For access to the SPARRA datamart (SPARRA Online), a SPARRA User Authorisation Form needs to be completed and returned to ISD. To request a form or for further information please contact the SHIS Support Team or SPARRA Team via email or by calling 0131 275 7050.

Appendix 2 – Data flow from collection to initial reporting

Appendix 3 - Attendances at Emergency Departments and A&E Services across Scotland
Health Board / Location Name / Jan-12 / Feb-12 / Mar-12 / Patient level data in A&E datamart
NHS SCOTLAND / 129,358 / 127,150 / 147,896
NHS Ayrshire & Arran / 9,488 / 9,107 / 10,846
ED
AyrHospital / 3,557 / 3,389 / 3,971 / Y
CrosshouseHospital / 5,628 / 5,452 / 6,538 / Y
MIU/other
ArranWarMemorialHospital / 184 / 138 / 157 / N
GirvanCommunityHospital / 87 / 86 / 108 / N
LadyMargaretHospital / 32 / 42 / 72 / N
NHS Borders / 2,123 / 2,084 / 2,446
ED
BordersGeneralHospital / 1,907 / 1,860 / 2,144 / Y
MIU/other
Hawick Cottage Hospital / 96 / 113 / 120 / N
HayLodgeHospital / 79 / 78 / 137 / N
KelsoHospital / 20 / 17 / 17 / N
KnollHospital / 21 / 16 / 28 / N
NHS Dumfries & Galloway / 3,668 / 3,522 / 4,221
ED
Dumfries & Galloway Royal Infirmary / 2,683 / 2,534 / 3,096 / Y
GallowayCommunityHospital / 901 / 901 / 1,053 / Y
MIU/other
CastleDouglasHospital / 32 / 18 / 23 / N
KirkcudbrightHospital / 30 / 42 / 22 / N
MoffatHospital / 3 / 5 / 5 / N
NewtonStewartHospital / 19 / 22 / 22 / N
NHS Fife (service change Jan 2012) / 7,189 / 6,829 / 7,968
ED
QueenMargaretHospital / 2,264 / x / x / Y
VictoriaHospital / 3,904 / 4,898 / 5,615 / Y
MIU/other
AdamsonHospital / 114 / 101 / 140 / N
QueenMargaretHospital / 629 / 1,475 / 1,794 / Y
St AndrewsMemorialHospital / 278 / 355 / 419 / N
NHSForthValley / 5,872 / 5,615 / 6,888
ED
ForthValleyRoyalHospital / 4,880 / 4,514 / 5,401 / Y
MIU/other
StirlingCommunityHospital / 992 / 1,101 / 1,487 / Y
NHS Grampian / 11,240 / 11,305 / 13,427
ED
Aberdeen Royal Infirmary / 5,111 / 5,040 / 5,745 / Y
Dr Gray's Hospital / 1,875 / 1,821 / 2,230 / Y
Royal Aberdeen Children's Hospital / 1,302 / 1,573 / 1,941 / Y
MIU/other
AboyneHospital / 49 / 65 / 76 / N
ChalmersHospital / 246 / 241 / 298 / N
Fleming Cottage Hospital / 17 / 31 / 30 / N
FraserburghHospital / 849 / 830 / 895 / N
Insch & DistrictWarMemorialHospital / 37 / 32 / 51 / N
InverurieHospital / 22 / 14 / 29 / N
JubileeHospital / 235 / 249 / 336 / N
KincardineCommunityHospital / 81 / 73 / 98 / Y
LeanchoilHospital / 36 / 41 / 47 / N
PeterheadCommunityHospital / 1,054 / 963 / 1,177 / N
SeafieldHospital / 57 / 61 / 65 / N
Stephen Cottage Hospital / 22 / 39 / 41 / N
TurnerMemorialHospital / 94 / 68 / 142 / N
Turriff Cottage Hospital / 153 / 164 / 226 / N
NHS Greater Glasgow & Clyde / 37,017 / 36,706 / 42,091
ED
Glasgow Royal Infirmary / 7,006 / 6,920 / 7,644 / Y
InverclydeRoyalHospital / 2,648 / 2,490 / 2,987 / Y
RoyalAlexandraHospital / 6,085 / 6,044 / 6,702 / Y
RHSC Glasgow / 3,625 / 3,962 / 4,878 / Y
Southern GeneralHospital / 3,932 / 3,934 / 4,298 / Y
Victoria Infirmary (ED) / 5,081 / 4,850 / 5,585 / Y
Western Infirmary / Gartnavel General / 4,987 / 4,756 / 5,463 / Y
MIU/other
StobhillHospital / 1,155 / 1,222 / 1,483 / Y
Vale of LevenDistrictGeneralHospital / 1,087 / 1,123 / 1,300 / Y
Victoria Infirmary (MIU) / 1,411 / 1,405 / 1,751 / Y
NHS Highland / 6,926 / 6,756 / 8,008
ED
BelfordHospital / 618 / 594 / 655 / Y
CaithnessGeneralHospital / 515 / 443 / 515 / Y
Lorn & IslandsDistrictGeneralHospital / 442 / 423 / 529 / N
RaigmoreHospital / 2,321 / 2,245 / 2,638 / Y
MIU/other
Aviemore Health Centre / 124 / 144 / 154 / N
Campbeltown Health Centre / 413 / 406 / 512 / N
CountyHospital Invergordon / 117 / 144 / 142 / N
Dunoon & DistrictGeneralHospital / 501 / 467 / 589 / N
DunarosHospital / 30 / 33 / 52 / N
DunbarHospital / 201 / 191 / 208 / N
IanCharlesHospital / 73 / 112 / 111 / N
IslayHospital / 65 / 79 / 66 / N
LawsonMemorialHospital / 19 / 28 / 34 / N
MackinnonMemorialHospital / 291 / 263 / 372 / N
Mid ArgyllHospital / 252 / 260 / 297 / N
Town and CountyHospital, Nairn / 289 / 292 / 364 / N
PortreeHospital / 200 / 180 / 239 / N
RossMemorialHospital / 116 / 146 / 175 / N
VictoriaHospital / 339 / 306 / 356 / N
NHS Lanarkshire / 15,587 / 15,427 / 17,836
ED
HairmyresHospital / 4,642 / 4,595 / 5,275 / Y
MonklandsHospital / 5,519 / 5,334 / 6,273 / Y
WishawGeneralHospital / 5,309 / 5,391 / 6,121 / Y
MIU/other
KelloHospital / 36 / 36 / 55 / N
LadyHomeHospital / 81 / 71 / 112 / N
NHS Lothian / 19,903 / 19,686 / 22,715
ED
RHSC Edinburgh / 3,015 / 3,439 / 4,336 / Y
Royal Infirmary of Edinburgh / 9,265 / 8,733 / 9,870 / Y
St John'sHospital at Howden / 4,246 / 4,180 / 4,825 / Y
Western GeneralHospital (ED) / 1,703 / 1,561 / 1,689 / Y
MIU/other
BelhavenHospital / 10 / 10 / 15 / N
Edington Cottage Hospital / 84 / 179 / 117 / N
Western GeneralHospital (MIU) / 1,580 / 1,584 / 1,863 / Y
NHS Orkney / 197 / 189 / 207
MIU/other
BalfourHospital / 197 / 189 / 207 / Y
NHS Shetland / 633 / 603 / 666
ED
GilbertBainHospital / 633 / 603 / 666 / Y
NHS Tayside / 8,886 / 8,687 / 9,831
ED
NinewellsHospital / 3,852 / 3,724 / 4,163 / Y
Perth Royal Infirmary / 1,944 / 1,939 / 2,263 / Y
MIU/other
Aberfeldy Cottage Hospital / 2 / 6 / 2 / Y
Arbroath Infirmary / 1,172 / 1,107 / 1,233 / Y
BlairgowrieCommunityHospital / 245 / 258 / 256 / Y
Brechin Infirmary / 240 / 223 / 274 / Y
CrieffCommunityHospital / 176 / 159 / 215 / Y
Links Health Centre, Montrose / 518 / 586 / 612 / Y
PitlochryCommunityHospital / 121 / 112 / 132 / Y
St Margaret's Hospital / 20 / 31 / 39 / Y
Whitehills Health & Community Care Centre / 596 / 542 / 642 / Y
NHS Western Isles / 629 / 634 / 746
ED
WesternIslesHospital / 527 / 516 / 593 / y
MIU/other
St Brendan's Hospital / 18 / 41 / 32 / n
Uist & BarraHospital / 84 / 77 / 121 / n

Appendix 4 – Frequent Attenders Definition

Definition

Notes:

1. It is important to note the pattern and cluster of attendances an individual may make e.g. a patient in Mental Health crisis may attend frequently over a short period of time, it is therefore essential to engage with primary care as soon as possible to ensure they can intervene as appropriate (recognising that real-time response will be challenging).

2. Frequent attendances should not be geographically limited to 1 Emergency Department. (ISD Scotland are developing a report which will help to identify these patients who may attend either Emergency Departments within one Health Board or attend across Health Boards. Initially the report will be sent electronically to a named NHS Board contact. From April 2011 staff in each NHS Board who have the appropriate permissions to access the national A&E datamart will be able to refresh this report on a monthly basis (A&E2 SHIS rollout).
3. It is also important to include patients that attend but leave before either being seen or treatment has been completed.

Suggested Guidance

Each ED should have a policy for dealing with frequent attenders – this can be adapted locally but as a minimum should include the following;

If not already available the Emergency Department IT system should be set up to automatically identify frequent attenders (based on the definition above).
On a monthly basis the attendances should be analysed to identify frequent attenders.
Once a patient has been identified as a frequent attender an alert should be added to that patients details on the Emergency Department IT system (if this functionality exists) which can be seen by both reception and clinical staff. If an IT system is not in place a manual register of frequent attenders should be maintained and reviewed monthly. It is suggested that this is maintained by reception staff as this would ensure that any frequent attenders who arrive and do not wait to be seen are also captured.
Once the patient has been identified as a frequent attender, the patients GP should be contacted by letter (cc’d to the patient where appropriate) stating that;
this patient is a frequent attender, noting the number of attendances, date and time of all attendances and reason for each attendance.
The letter should request that the GP follows up the frequent attendance issue with the patient and other agencies such as NHS24, SAS Social Services and Police, as appropriate,
This is in addition to any standard GP letters that are generated following an attendance.
If the patient attends multiple Emergency Departments, across Board boundaries then it is the responsibility of the NHS Board of residence to contact the GP.
Existing ED practice should be followed for patients who are not registered with a GP Practice and are a Scottish resident ie. information passed to them on how to register with a Practice.

Review of Frequent Attender Status

Patients identified as frequent attenders should be reviewed on a regular basis to ensure that the alert is still valid. For example if after a year the patient has not attended the department then the flag could be removed. Who does this is dependant upon each local set up e.g. this could be automated within the IT system.

Current Practice

Examples of existing practice for managing frequent attenders, in some Emergency Departments can be found on the Emergency Access Delivery Team Community on shared space

Please contact to request access to this community.

ISD Scotland – May 2012