Emergency Care Data Set (ECDS) Emergency Department Show and Tell No.4, 11 April 2018 Dr Tom Hughes, ECDS lead clinician (Royal College of Emergency Medicine) Rozanne Addams, Project Manager (NHS Digital) Emma Fernandez, ECDS project manager (Royal College of Emergency Medicine) Version: v1.0 The ECDS project is a collaborative project between the Department of Health, the Royal College of Emergency Medicine, NHS England, NHS Digital, NHS Improvement, NHS Providers and Public Health England. This document has been produced on behalf of the ECDS Project Board in collaboration with the organisations listed above.

Before we start We are recording the webinar for the benefit of other services Most people will be muted – please send your comments and questions via the WebEx chat function We’ll be running a simple poll a bit later We’ll share the following after the meeting: The slides The links to the recordings The transcript of the QA session along with written answers EF to do

On this afternoon’s call we will be covering: An introduction to the ECDS Clerical data items Clinical data items Acuity Chief Complaint Diagnosis & the diagnosis qualifier Clinician details Injury and Information Sharing for Tackling Violence (ISTV) Investigations and Treatments

ECDS data set Mixture of Mandatory, Required or Optional data items Adapted from previous Commissioning data set for A&E Data capture mix of real time and retrospective data Data capture by mix of staff Introduction of SNOMED CT for some subsets

ECDS data set cont. Changes to existing CDS Type 010 data items Attendance Category Source of Referral Diagnosis (& diagnosis qualifier) Investigations & Treatments Attendance Disposal code – Discharge status/Discharge Destination/Discharge Follow up Clinician details New data items Chief Complaint Diagnosis Qualifier Acuity Injury

ECDS – Clerical data items Revised data items, code sets uplifted: Arrival mode Attendance category Attendance source New data items, to provide more information regarding equity of access and demographics: Accommodation status Spoken language and interpreter required https://www.dropbox.com/s/2u3b9w0yuy2b7z7/ECDS_demo.mp4?dl=0 Click on link to go through presentation of entering data

Demonstration of data entry https://www.dropbox.com/s/2u3b9w0yuy2b7z7/ECDS_demo.mp4?dl=0

Crib sheets

ECDS – Mental Health Act Start data/time, Expiry data/time and Mental Health Act Legal Status Classification Code To support better understanding of activity relating to patients brought in by Police under Section 136. A ‘Required’ data item – but only relevant to patients under section 136. May collect in the department already, now need to capture some of this information in the ED system

ECDS - Acuity A ‘measure of the urgency & severity of the condition with which the patient presents to the ED Defined by the first clinician who assesses the patient. The initial assessment of acuity. Represented as a number between ‘1’ (most serious) and ‘5’ (least serious). ED’s may already use an existing scoring system e.g. Manchester, Australian or Canadian triage or an early warning score e.g. NEWS, PEWS.

ECDS - Acuity Where an existing acuity assessment in use 1-5 score No existing acuity assessment, then acuity defined by physical area of treatment:

ECDS – Chief Complaint The patient’s ‘reason’ for attending Patient’s chief complaint as defined by the clinician first assessing the patient. Does not require a triage process may be collected as part of a triage process.

ECDS – Diagnosis Design principles: Exhaustive: conditions commonly seen in EDs Exclusive: should be one and only one best answer. No symptoms. No vague items e.g. ‘unwell’

ECDS pilot – Diagnosis Pre & Post Pre = 74% of the top 10 patients = meaningless Post = all diagnosis meaningful

ECDS – Diagnosis, common questions 1. Where is the code for ‘non-specific abdominal pain’ / ‘back pain’? There isn’t one 2. Where is the code for ‘generally unwell’? No abnormality detected URTI Influenza

ECDS – Diagnosis, common questions 3. How can I code ‘diagnosis X excluded’ e.g. pulmonary embolus excluded? Prohibited under NHSD rules due to clinical risk e.g. danger ‘brain tumour excluded’ -> ‘brain tumour’ In the diagnosis field : what you suspect Write ‘XXXX excluded’ in the clinical narrative 4. Where is the diagnosis code for [rare condition] 50 Clinician years to develop + testing in pilot sites 250k / year pseudopseudohypoparathyroidism = ‘other endocrine condition – free text’. No symptoms, no fluffy terms 5. I believe diagnosis [ ‘XYZ’ ] should be included in DDS, what should I do? Please submit request via ECDS feedback form

ECDS – Diagnosis qualifier Capture the ‘uncertainty’ of diagnosis, qualifiers are: ‘Confirmed diagnosis’ - beyond reasonable doubt. ‘Suspected diagnosis’ threshold for proof not met Covers probable (= more likely than not), possible (feasible) In the GP letter For a confirmed diagnosis : Diagnosis = “closed fracture neck of femur” For a suspected diagnosis: Diagnosis = “short of breath (chief complaint) : suspected diagnosis = pulmonary embolus”

ECDS – Care Professionals Tier Treating AND REVIEWING clinicians Code Description Example 1 Require complete supervision / All patients must be signed off by a senior before admission or discharge. F1 doctors, trainee practitioners 2 Require access to advice or direct supervision, or practice independently but with limited scope of practice ENPs, ANPs / ACPs, PAs, ESPs, F2 doctors, CT1-2 doctors, some primary care clinicians 3 More senior / experienced clinicians, requiring less direct supervision - Fewer limitations in scope of practice CT3 in EM, junior Speciality Doctors, senior ANPs / ACPs / PAs, some primary care clinicians 4 Senior clinicians able to supervise an Emergency Department alone with remote support. Possess some extended skills. Possess some extended skills - Full scope of practice. CT4 and above, senior Speciality Doctors 5 Senior clinicians with accredited advanced qualifications in EM. Full set of extended skills - Full scope of practice. Consultants in EM

ECDS – Care Discharging clinician Clinician who discharges patient responsible for making sure that all treatment is complete responsible for completing coding and discharge documentation. Automatically populated by the emergency department IT system: at the time patient discharge OR When the GP discharge documentation is completed Only one clinician must be responsible for the patient’s discharge.

ECDS – Injury Consistent, integrated and more efficient method of recording data. date/time, place, intent, activity, mechanism, drug/alcohol involvement ‘Required’ when attendance from injury (via CC / Diagnosis flags). Collected by clerical staff ISTV ECDS code sets developed to support collection of ISTV ECDS does not stop flow of ISTV data via local data sharing agreements Free text (place and mechanism) must be collected – not part of ECDS.

Investigations and Treatments These are linked with HRG codes The investigations and treatment data flow into the SUS (Secondary Uses Service) data warehouse in NHS Digital From there the data are used by the HRG ‘grouper’ to generate a Healthcare Resource Group (HRG). The HRG determines the tariff – the money payable by the commissioner to the healthcare provider Care was taken to ensure that the new data collections would not lead to a large shift in payments

Investigations and treatments Common queries Verbal advice I can’t see a code for: ANCA screen CSF glucose Sickle cell PR medication

Other Useful Information User Guidance ED / Informatics staff to capture and submit better quality data Technical Guidance IT / Informatics teams e.g. MESH / XML deployment guidance Posters / Crib sheets will be available to help ED staff enter new data items

ECDS Poll Questions: 1. How confident are you that you will be able to start collecting data by 1st October 2018? 2. Have you had contact with your IT supplier regarding ECDS? 3. What changes do you have to make in order to collect ECDS data?

Next steps…. Make sure colleagues in the department are aware of ECDS, specifically Clinical Directors/Leads Make sure that trust informatics/business managers are aware and find out who is leading ECDS implementation for your department Familiarise yourself with the data set, and work with colleagues to identify where changes to the data set may impact ED processes or trusts systems. Familiarise yourselves with the code sets particular Chief Complaint, Diagnosis, Investigations and Treatments. Updated ECDS User Guidance and FAQ’s will be published in the next few weeks If you think we have missed something or something needs changing let us know: ECDS feedback form

Send your queries/comments to : ECDS@nhs.net Future webinars…. Would further ED focused webinars be useful or shall we merge with others from the 16th May? We plan to hold a ECDS webinar roughly every 3 weeks, They’re totally open – invite anyone Future topics will include: HES transition EDSSS update by PHE (ED Syndromic Surveillance) Detail on the user guidance / technical guidance A focus on the early adopters scheme Implementation support – materials Performance management / SitRep / 4 hour Benefits case studies Let us know anything particular you’d like us to cover again or in more detail Next ECDS webinar is 16th May. 14:00-15:30 Next webinar focused on Commissioners is 26th May. 14:00-15:30 Send your queries/comments to : ECDS@nhs.net