Emergency Care Data Set (ECDS) Attendance, streaming, referrals and discharge 10th May 2018 Tom Hughes, ECDS Clinical Lead Emma Fernandez, ECDS Project Manager Andrew Clayton, Project Manager, NHS Digital Saeed Daji, Operational Delivery Administrator, NHS Digital 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.

Send your comments to : ECDS@nhs.net Before we start We are recording the webinar for the benefit of others Please send your comments and questions via the WebEx chat function to “everyone” We’ll share the slides etc. after the meeting Supporting documents are available on the ECDS web page (www.content.digital.nhs.uk/ECDS) This includes all webinars and downloads Send your comments to : ECDS@nhs.net

On this afternoon’s call: Attendance information Crib sheets Streaming and counting Referrals Discharge and follow up

Arrival

Accommodation status Scenario Correct coding (SNOMED-CT description) Patient who is a foreign national or currently on holiday Housed (finding) Currently sleeping on a friends sofa Patient refuses to disclose type of accommodation they usually reside in Declines to provide accommodation details (finding) Patient is unconscious on arrival with no other source of accommodation data Unable to provide accommodation details (finding) Student living in university accommodation in term time Currently an inpatient in a drug rehabilitation service Lives in hospital (finding)

Language “What is [your] [the person’s] preferred language?” Where a person is unable to consent for themselves (e.g. baby, child or who lacks capacity for any other reason) then the language of the person who is consenting will be recorded. For example a parent / guardian or someone with lasting power of attorney.

Attendance source Scenario Correct coding “I was referred by the GP” Referred by member of Primary Health Care Team (finding) “I was advised to attend by my GP’s practice nurse” “I was advised to attend by NHS 111” Referred by National Health Service 111 service (finding) “I was referred by my friend who is a practice nurse” Self-referral to accident and emergency department (procedure) “I consulted an online GP who advised me to attend” Advised to attend accident and emergency department (situation) “I was hit my leg playing football and my friends called an ambulance”

Four crib sheets are available Reception staff guidance Acuity / chief complaint [NB: Lorenzo] Injury guidance Common diagnoses We are now able to post 10 copies of each per ED to you on request. Email ECDS@nhs.net with: Receiving person’s name Address How many ED’s it’s for (or one request per ED) You may already have downloaded and printed local copies (https://digital.nhs.uk/ECDS-guidance). If there are spare copies and you need more, we will send these later.

Streaming guidance

Minimum ECDS Streamed data set Patient Name Patient Identification - NHS number / demographics Arrival Date / Time (automatically entered) Chief Complaint Acuity Discharge Status – service to which streamed Departure Date / Time (automatically entered) ECDS does not define streaming process ECDS just defines the data collected, not how streaming occurs. Only CC and acuity need collecting at point of streaming The rest can be collected before or after depending on the model used. [should the first person that the patient meets be clinical?]

Streaming options Streamed to primary care service / GP Streamed to Urgent Care Centre Streamed to Emergency Department Streamed to Ambulatory Emergency Care service Streamed to falls service Streamed to frailty service Streamed to mental health service Streamed to pharmacy service Streamed to dental service Streamed to ophthalmology service Streamed to Emergency Department only used when patient is streamed from UTC / type 2 (Specialist ED) / type 3 (MIU) / type 4 (Walk in Centre)

Capturing streaming in ECDS Key points Streaming = 1x complete ECDS episode Streaming does not attract tariff 4 Hr standard start from first streaming Reported through standard ECDS structure

Scenario A Alice falls breaking her femur and is taken to the ED. Straightforward type 1 ED attendance attracts tariff four-hour standard applies. Type 1 ED

Scenario B Bob sustains a 5 cm laceration to his arm. Attends ED, streamed to co-located GP. Two ECDS patient episodes one streaming, attracts no tariff one type 3, which attracts tariff. Four-hour standard applies from the time of streaming Stream to GP Type 3 ED

Scenario C Carol sustains a 5 cm laceration to his arm. Attends ED, streamed to adjacent UTC Two ECDS patient episodes one streaming, attracts no tariff one type 3, which attracts tariff. Four-hour standard applies from the time of streaming Stream to UTC Type 3 ED

Scenario D Dan - 62-year-old man, presents to ED with a toenail infection, streamed to co-located UTC. On arrival at the UTC it turns out he has a fever and diabetes and is streamed back to the ED. Three ECDS episodes Two streaming – attract no tariff One treatment – attracts tariff four-hour standard applies from first streaming Stream to UTC Stream to ED Type 1 ED

Patient leaves

Absconders and walk outs Register but leave before triage No information can be gathered for chief complaint, acuity, diagnosis, referral Discharge status: Left care setting before initial assessment (finding) Discharge destination: Discharge to home (procedure)

Absconders and walk outs Left after triage, before seen by clinician Chief complaint, acuity entered Nothing for diagnosis or Professional registration, investigation or treatment Discharge status: Left care setting after initial assessment (finding)

Absconders and walk outs Left after seen by clinician, before investigations/ treatment Chief complaint, acuity, diagnosis entered Nothing for investigation or treatment Discharge status: Left care setting before treatment completed (finding)

Referrals

Multiple referrals Patient presents with abdominal pain, she is first referred to surgical on-call and then to on-call gynaecology team: Referral to surgeons

Emergency care discharge summary

Emergency care discharge summary standard The standard is practical and easy to implement as it was led and designed by the professionals who will be using it. The project was commissioned by NHS Digital and managed by the PRSB, supported by the Royal College of Physicians Health Informatics Unit. https://theprsb.org/standards/emergencycaredischarge/

What will it mean for patients and professionals? NHS Digital has developed technical standards so that the e-discharge summary can be implemented across the UK. It means GP systems can pull the information straight through from hospitals. The standard NHS contract mandates providers to use PRSB headings to structure the discharge summary - from October 2018 they will be need to send structured and coded discharge summaries to GPs Details on emergency visits will be available more quickly to GPs to improve on-going patient care. Key information will directly enter the GP record, reducing the risk of transcription errors and improving the safety of care.  

www.theprsb.org info@theprsb.org @ProfRecordsSB

General QA – your questions