Clinical Questions Answered Explore Discovery Clinical Questions Answered by Discovery Background: The Senior Clinical Leadership Fellows developed this set of questions. This document highlights how Discovery can be used to access information to help investigate these areas. Hyperlinks are provided on each slide in order to take the user to the relevant Discovery Dashboard (appropriate Discovery access is required)

Q1a - How has the readmission rate to General Medicine changed over the last 12 months compared to other Health Boards? Discovery Level 1 Overview Dashboard The Level 1 overview (treatment) dashboard provides information on a number of treatment indicators, including 7 & 28 day standardised readmission rates. Clicking on an indicator displays a detailed indicator tab (see right). The user selected location is the largest dot in the distribution. Shows a trend view for your selection compared to a peer rate, and a year on year % change. Comparison with peer locations for the selected time period. Specialty view - User can choose a particular specialty from the filter. The bar shows your rate, green line shows the peer average for that specialty. Link to more detailed readmission information at Level 2. Patient listings are available within Level 3 dashboards. A Residence-based Level 2 dashboard is available to provide more detailed information for the original discharging stay and the readmission stay.

Q1b - How has my readmission rate to General Medicine changed over the last 12 months compared to colleagues in my Board? Consultant Team Dashboard Level 2 Dashboard - Overview tab The Consultant Team dashboard provides information on a number of treatment indicators that can be shown by Consultant GMC number. This includes Outpatient, Day Case and Inpatient activity, as well as readmission rates. Users can refine the views using the display filters. Users can create specific consultant teams using the GMC code filter. As the dashboard is dynamic, clicking on an indicator updates the visualisation. Information available by individual GMC number or showing the trend.

Q2 -Where do residents of our Health Board receive their elective inpatient care? Cross Boundary Flow Dashboards These dashboards are available at Level 1 and Level 2. This slide shows a Level 1 view. Cross Boundary Flow dashboards allow users to identify which Health Board is providing treatment to their residents, or which residents they are treating. Users can view information for a range of activity types. At Level 1 users can see this information by specialty Clicking on a bar (or multiple bars) in the chart will display a second chart and which shows the hospitals where care is being delivered. (4). The Level 2 views identify the specific procedures being undertaken as well as the diagnoses. GP practice information is also available.

Q3 - What is the actual waiting time for elective care within our Health Board for different specialties, and how does that compare with other Health Boards? Discovery Level 1 Overview Dashboard There are a number of indicators in Discovery which provide information on elective waiting times: 12 week IPDC waiting times 12 week New OP Waiting Times 18 week CAMHs 18 week Psychological therapies 18 week Referral To Treatment In this example 12 week IPDC waiting times are shown. Users can choose an individual specialty and visualisations will update for the chosen specialty. As there are national standards for 12 week IPDC waiting times, locations that are meeting the standard are coloured green and coloured red if they are not. The darker the colour of the bar in the specialty bar chart the greater the activity.

Q4 - How many patients attend hospital (not A&E) as an emergency but are discharged without an overnight stay ? Hospital Spell Analysis Dashboard Level 2 Dashboard - Hospital tab This dashboard provides users with the functionality to assess a range of information relating to hospital activity. The screenshot displayed is filtered to only show non-elective admissions with a zero day length of stay. Hospital Summary table provides information for all hospitals within the users Health Board for the selected time period. Trend chart shows monthly activity changes. The Year on Year % change chart shows how monthly activity has changed compared to the same month of the previous year. Data table also provided. A length of stay distribution chart shows the proportion of discharges by length of stay (note, in the example screenshot, only 0 days has been selected). Users can use this information to compare length of stay profiles for hospitals for any condition/procedure (using the relevant filters).

Q5 - How do the characteristics of my team/specialty/hospital/Health Board’s emergency admissions compare to my colleagues/peers? Hospital Spell Analysis Dashboard Level 2 Dashboard - Diagnosis/Consultant tab This tab provides information on all conditions for patients admitted to hospital. The example is filtered to show non-elective admissions which are discharged from General Medicine. Users can analyse the information by the number of hospital spells or by bed days utilised. Users can create their own consultant team and focus on a specific hospital/specialty/age group/condition/procedure. The top 20 conditions are displayed based on the selections made. The bar chart shows activity for all conditions. Activity is available by the discharging consultant. There is a separate Procedure/Consultant tab that provides similar analysis for the 1st main procedure recorded within the hospital spell.

Q6 - Did the mortality from sepsis in my hospital significantly differ from that in other hospitals for a specific time period. Is it changing over time? Clinical Profiles Home Page Level 1 Dashboard Sepsis Funnel Plot tab There are a number of Clinical Profile dashboards looking at different conditions including: Atrial Fibrillation Emergency Laparotomy Sepsis Urology Venous Thromboembolism (VTE) Clinical Profiles present outcome indicators for a range of medical and surgical activity at hospital level. They are updated on a quarterly basis. The definitions of the indicators for each profile were developed in consultation with clinicians and include: length of stay, emergency readmission and mortality. Run chart information is also available that compares changes over time.

Q7 - How many new outpatient appointments were made in the last 3 months for local patients to surgical clinics held at centres outside our Health Board area? Cross Boundary Flow Discovery Level 2 Dashboard Level 2 Dashboard - Residence Specialty Outpatients tab In this example, a specific Health Board of Residence has been selected and all other Health Boards of treatment are then shown. Specialty Group of Surgery has been chosen; users can select any specialty, time period or GP practice. User can see the Health Board and location of treatment. Displays the GP practice of the patient. Specialty of the outpatient appointment and the total activity.

Q8a - As part of the evaluation of the Board’s redesign of our General Surgical service, how can we use Discovery to assess this impact? Discovery Level 1 Overview Dashboard Level 1 Dashboard - Health Board Overview tab The Level 1 overview (treatment) dashboard provides information on a number of treatment indicators. Users can select individual specialties which will provide a specialty specific overview. Different date ranges can be chosen. 1. The Health Board Overview tab compares the Health Board’s performance with other Health Boards. Clicking on a specific indicator will take you to the detailed indicator view. This indicator view contains trend charts for the last 3+ years. The user selected location is displayed as the larger dot. The Location Overview tab allows the user to select a specific hospital and compare performance (See next slide). Custom Peers tab - Users can choose their own bespoke peer list in this tab.

Q8b:- As part of the evaluation of the Board’s redesign of our General Surgical service, how can we use Discovery to assess this impact? Discovery Level 1 Overview Dashboard Level 1 Dashboard – Location Overview tab – Within Board view The Location Overview tab provides comparisons for a selected location against their peer hospitals. Or if the ‘Within Board’ option is chosen all hospitals within the Health Board are compared against each other. 1. Within Board option chosen - All the Board hospitals are compared to each other. The user selected location is the larger dot. Clicking on a specific indicator will open a detailed indicator view. Selected location performance is compared to Health Board and Scotland. Lists all peer locations Possible to download all data as a CSV extract. Custom Peers - Users can choose their own bespoke peer list in the Custom Peer tab. There are also a number of indicator specific Level 2 dashboards that provide more detailed information.

Q9 - How many patients have had more than one admission in the past 12 months? What are their characteristics and what conditions have they been treated for/treatments have they received? Multiple Emergency Admissions Level 1 (Residence) Dashboard The multiple emergency admissions dashboard identifies activity and rates of multiple emergency admissions. Information is based on Health Board/Local Authority of Residence Users can analyse information for 6 main conditions (Asthma, CHD, COPD, Diabetes Mellitus, Hypertension and Stroke/TIA). Comparisons across all Health Boards are available. Dashboard is dynamic, clicking on a specific Health Board will show how the rate compares to all other Boards. Time Trend chart also available.

Q10 - How does my hospital compare to others in Scotland with regards to the diagnoses for ambulatory care conditions that could potentially be managed without an overnight stay? BQBV Dashboard Ambulatory Care Level 1 Dashboard - Health Board Comparison tab This dashboard provides information for 49 conditions that have been identified as potentially being able to be treated as an Ambulatory care scenario. Analysis available by: Ambulatory Care (% of admissions) Potential Opportunity (Admissions + Length of Stay) Potential beds freed up Potential savings More detailed information is also available for each of the individual ambulatory care conditions, including trend information.

Q11 - In the last year, which of the Procedures of Low Clinical Value is my hospital performing most of? Is this in keeping with other areas? And what is the associated cost? BQBV-Procedures of Low Clinical Value Level 1 Dashboard - Procedures of Low Clinical Value Comparison tab This dashboard provides information on procedures of low clinical value. It compares observed activity with expected activity, (after standardisation) and calculates potential savings if the expected activity occurred. Comparative Health Board information is also available within this dashboard which allows users to compare activity for each Procedure of Low Clinical Value against other Health Boards.

Q12 - We have been working with GP practices as part of the Board’s respiratory drug formulary review. Where can we get data on prescription costs by practice over time? Prescribing Primary Care Cost per 1,000 Patients per Day (£) Level 2 Dashboard - GP Practice tab Within this Dashboard information is available that shows Prescribing Primary Care Cost per 1000 patients per day for individual GP practices. This information can be split by BNF Chapter and Section and the user can interact with the chart to provide monthly trend information by individual GP practice. Hovering over the GP practices makes a tool tip appear that provides further information. Selecting GP practices updates the trend line graph to allow comparison over time. If no specific GP practice is selected in the scatter plot, the table will display information for all GP practices.

Discovery Hints and Tips The A to Z page : highlights all the information available in Discovery and provides specific links to this information. Tool Tips: Throughout Discovery if the user hovers their cursor over any of the charts or data points a tool tip will appear with additional information Custom Views: Within each dashboard area it is possible to save specific visualisations (Custom Views) incorporating any filter selections the user has made. Pause button: Clicking on the ‘Pause’ button allows users to make all of their filter selections at once rather than one at a time. Dynamic visualisations: Many of the dashboards in NSS Discovery are dynamic. This means that if you click on one area of a chart/table it will update the other areas/panels to reflect this choice. Exporting data from Discovery: To export data, select the chart or table containing the information you wish to export (by clicking on it), then click on the button (normally located near the top right of the dashboard) and choose the format you wish the data to be exported in. Metadata: - detailed metadata is available via the head icon at the top right of all dashboards.

For Discovery support and more information on accessing and using NSS Discovery, email us at:  nss.discovery@nhs.net or visit our website: www.nssdiscovery.scot.nhs.uk