ASE Event Slides  Major Trauma  Sepsis  QIPP 114 June 2010

Table of Contents – Indicators for ASE Event Major Trauma o MTrauma1 – Standardised Mortality Rates o MTrauma2a – Trauma Related Mortality o MTrauma2b – Trauma Related Mortality per 100,000 o MTrauma3 – Number of pre-hospital trauma related deaths o MTrauma4 – Variation in secondary transfers by site o MTrauma5 – Number and proportion of all admissions that are Major Trauma related o MTrauma6 – Length of stay for major trauma admissions by acute trust o MTrauma7 – Variation in total rehab bed days per site o MTrauma8 – Ratio of rehab episodes / number of trauma episodes by site Sepsis o Sepsis 1a: Number of deaths due to Sepsis in the North East o Sepsis 1b: Number of deaths due to Sepsis in the North East per 100,000 o Sepsis 1c: Number of in –hospital deaths related to Sepsis in the North East o Sepsis 2a: ICU bed days for Sepsis related admissions o Sepsis 2b: Bed days for all Sepsis related admissions o Sepsis 3: Cost of Sepsis related admissions QIPP o QIPP1a: Number of emergency admissions by Acute Trust o QIPP1b: Proportion of emergency admissions versus all admissions by Acute Trust o QIPP2a: Number of 28d emergency re-admissions by Acute Trust o QIPP2b: Proportion of 28d emergency re-admissions by Acute Trust versus all emergency admissions o QIPP3: Emergency Length of Stay per site o QIPP4a: Ambulatory care sensitive as a % of admitted cases per site o QIPP4b: Percentage difference in emergency admissions with an ambulatory care condition compared to national average for each SHA o QIPP5: A & E Attendances, England to

MTrauma1 – Standardised Mortality Rates Table 1: Data 3 Data obtained from TARN, January 1st 2006 and December 31st 2010 NOTE –CDDFT, NTHFT, NHFT and STFT either do not submit to TARN or have low case counts and are not displayed

MTrauma2a – Trauma Related Mortality Table 1: Data 4 Data obtained from ONS: 2005, 2006, 2007, 2008, using ICD U50.9,V01-Y89 (External causes of morbidity) NOTE – ALL external causes of morbidity are included, which is a proxy measure for Trauma related deaths.

MTrauma2a – Trauma Related Mortality Chart 1: Time Series 5 Data obtained from ONS: 2005, 2006, 2007, 2008, using ICD U50.9,V01-Y89 (External causes of morbidity) NOTE – ALL external causes of morbidity are included, which is a proxy measure for Trauma related deaths.

MTrauma2b – Trauma Related Mortality per 100,000 resident population Table 1: Data 6 Data obtained from ONS: 2005, 2006, 2007, 2008, using ICD U50.9,V01-Y89 (External causes of morbidity)

MTrauma2b – Trauma Related Mortality per 100,000 resident population Chart 1: Time Series 7 Data obtained from ONS: 2005, 2006, 2007, 2008, using ICD U50.9,V01-Y89 (External causes of morbidity)

MTrauma3 – Number of pre-hospital trauma related deaths Table 1: Data 8 Data obtained from Not able to complete within current timescales

MTrauma3 – Number of pre-hospital trauma related deaths Chart 1: Time Series 9 Data obtained from Not able to complete within current timescales

MTrauma4 – Variation in secondary transfers by site Table 1: Data 10 Data obtained from Not able to complete within current timescales

MTrauma4 – Variation in secondary transfers by site Chart 1: Time Series 11 Data obtained from Not able to complete within current timescales

MTrauma5 – Number and proportion of all admissions that are Major Trauma related 12 Table 1: Data (% of all admissions that are trauma episodes) 12 Data obtained from HES 2009/10 Table 1b: Data (number of trauma episodes)

MTrauma5 – Proportion of all admissions that are Major Trauma related Chart 1: Time Series 13 Data obtained from HES 2009/10

MTrauma6 – Length of stay (days) for major trauma admissions by acute trust Table 1: Data 14 Data obtained from HES 2009/10

MTrauma6 – Length of stay (days) for major trauma admissions by acute trust Chart 1: Stacked Bar Chart 15 Data obtained from HES 2009/10

MTrauma6 – Length of stay (days) for major trauma admissions by acute trust Chart 2: Box whisker plot 16 Data obtained from HES 2009/10

MTrauma7 – Variation in total rehab bed days per site Table 1: Data 17 Data obtained from Not able to complete within current timescales

MTrauma7 – Variation in total rehab bed days per site Chart 1: Time Series 18 Data obtained from Not able to complete within current timescales

MTrauma8 – Ratio of rehab episodes / number of trauma episodes by site Table 1: Data 19 Data obtained from Not able to complete within current timescales

MTrauma8 – Ratio of rehab episodes / number of trauma episodes by site Chart 1: Time Series 20 Data obtained from Not able to complete within current timescales

Sepsis 1a: Number of deaths due to Sepsis in the North East Table 1: Data Data obtained from ONS: 2005, 2006, 2007, 2008, using ICD A40-A41 (Septicaemia ) 21

Sepsis 1a: Number of deaths due to Sepsis in the North East Chart 1: Time Series 22 Data obtained from ONS: 2005, 2006, 2007, 2008, using ICD A40-A41 (Septicaemia )

Sepsis 1b: Number of deaths due to Sepsis in the North East per 100,000 resident population Table 1: Data Data obtained from ONS: 2005, 2006, 2007, Mid year Primary Care Organisation population estimates from ONS, 2005, 2006, 2007,

Sepsis 1b: Number of deaths due to Sepsis in the North East per 100,000 resident population Chart 1: Time Series 24 Data obtained from ONS: 2005, 2006, 2007, Mid year Primary Care Organisation population estimates from ONS, 2005, 2006, 2007, 2008

Sepsis 1c: Number of in hospital deaths related to Sepsis in the North East Table 1: Data Data obtained from HES: 2009/10, Diagnosis in any position for A40-A41 25 NOTE – Most recent year of data available from ONS is Table above based on HES 2009/10

Sepsis 1c: Number of in hospital deaths related to Sepsis in the North East Chart 1: Time Series 26 Data obtained from HES: 2009/10

Sepsis 2a: ICU bed days for Sepsis related admissions Chart 1: Data Data obtained from ONS 2005, 2006, 2007,

Sepsis 2a: ICU bed days for Sepsis related admissions Chart 1: Time Series 28 Data obtained from HES: 2009/10 NOTE – Max for GHFT, STHFT and NUTHFT is beyond scale of y-axis

Sepsis 2b: Bed days for all Sepsis related admissions Table 1: Data 29 Data obtained from HES: 2009/10

Sepsis 2b: Bed days for all Sepsis related admissions Chart 1: Time Series 30 Data obtained from HES: 2009/10 NOTE – Max for GHFT, STHFT and NUTHFT is beyond scale of y-axis

Sepsis 3: Cost of Sepsis related admissions Table 1: Data Data obtained from HES : 2009/10 31

QIPP1a: Number of emergency admissions by Acute Trust Table 1: Data Data obtained from HES: 2009/10 32 Note: Q4 2009/10 data from HES may not be complete. Numbers for City Hospitals Sunderland Foundation Trust are low.

QIPP1a: Number of emergency admissions by Acute Trust Chart 1: Time Series 33 Data obtained from HES: 2009/10 Note: Q4 2009/10 data from HES may not be complete.

QIPP1b: Proportion of emergency admissions versus all admissions by Acute Trust Table 1: Data 34 Data obtained from HES: 2009/10 Note: Q4 2009/10 data from HES may not be complete.

QIPP1b: Proportion of emergency admissions versus all admissions by Acute Trust Chart 1: Time Series 35 Data obtained from HES: 2009/10 Note: Q4 2009/10 data from HES may not be complete.

QIPP2a: 28d emergency re-admission rate by Acute Trust Table 1: Data 36 Data obtained from NHS Comparators: 2006/07, 2007/08, 2008/09, 2009/10

QIPP2a: 28d emergency re-admission rate by Acute Trust Chart 1: Time Series 37 Data obtained from NHS Comparators: 2006/07, 2007/08, 2008/09, 2009/10

QIPP2b: Proportion of 28d emergency re-admissions by Acute Trust versus all emergency admissions Table 1: Data 38 Data obtained from HES: 2009/10 Not able to complete within current timescales

QIPP2b: Proportion of 28d emergency re-admissions by Acute Trust versus all emergency admissions Chart 1: Time Series 39 Data obtained from HES: 2009/10 Not able to complete within current timescales

QIPP3: Emergency Length of Stay (days) per site Table 1: Data 40 Data obtained from HES: 2009/10

QIPP3: Emergency Length of Stay (days) per site Chart 1: Time Series 41 Data obtained from HES: 2009/10

QIPP3: Emergency Length of Stay (days) per site Chart 2: Box and whisker 42 Data obtained from HES: 2009/10

QIPP4a: Ambulatory Care Sensitive Cases that are admitted as a proportion of admitted cases per Trust Table 1: Data 43 Data obtained from HES: 2009/10

QIPP4a: Ambulatory Care Sensitive Cases that are admitted as a proportion of admitted cases per Trust Chart 1: Time Series 44 Data obtained from HES: 2009/10 Note: Q4 2009/10 data from HES may not be complete.

QIPP4b: - Percentage difference in emergency admissions with an ambulatory care condition compared to national average for each SHA Chart 1: Bar Graph 45 Data obtained from NHS Comparators Emergency Admission Data

QIPP5: - A & E Attendances, England to Chart 3: Time Series Analysis Data obtained from NHS Comparators Emergency Admission Data 46

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DATA SPECIFICATIONS HIGH LEVEL NOTES  Major Trauma 14 June

MTrauma1 – Standardised Mortality Rates Data Source: The Trauma & Audit Research Network (TARN)(TARN) Data Details: TARN data are presented as rates of survival adjusted for potential risk factors including age, gender, severity of injury and a patient’s own response to a certain injury Indicator: Adjusted difference in survival (actual survivors minus expected survivors adjusted per above) by hospital for all hospitals in the NE as reported on TARN Data Handling Notes: Use the TOTAL line of data (survival band) as reported in the Rate of Survival Breakdown at this Hospital for each hospital in the NE 4914 June 2010

MTrauma2 – Trauma Related Mortality Data Source: ONS, Death registration in England and Wales, Table 2: Deaths by age, sex and selected underlying cause Data Details: ONS data: ICD U50.9,V01-Y89 (External causes of morbidity) 2005, 2006, 2007, 2008 NOTE: This is a proxy measure for Trauma Related Mortality. All external causes of morbidity will include some deaths which are not related to Trauma. 66% of Trauma related admissions (See TARN ICD10 codes.pdf for ICD10 codes to use) have a secondary diagnosis of one of these external cause codes. Indicator: Number of trauma-related deaths by time period for the NE by PCT 5014 June 2010

MTrauma3 – Number of pre-hospital trauma related deaths Data Source: ONS, Death registration in England and Wales, Table 2: Deaths by age, sex and selected underlying cause HES for deaths in hospital for agreed trauma-related ICD10 codes Data Details: a) ONS data for number of trauma-related deaths b) Number of HES episodes with discharge method (dismeth) = 4 (died), Primary diagnosis (diag01) in list (See TARN ICD10 codes.pdf for ICD10 codes to use) Indicator: Number of pre-hospital trauma-related deaths Data Handling Notes: Number of pre-hospital trauma-related deaths calculated by subtracting trauma- related in-hospital deaths from total number of trauma-related deaths per ONS 5114 June 2010

MTrauma4 – Variation in secondary transfers by site Data Source: HES 2009/10 Data Details: Link episodes where: o end date of discharge episode = start date of next admission episode (transfer) linked by pseudo HES ID o admimeth of next episode = 81 (transfer of any admitted patient from another hospital provider other than in an emergency) o Dismeth of first episode not equal to 4 (died) o Primary diagnosis (diag01) and first secondary diagnosis code (diag02), if required, for both episodes in the list of trauma-related ICD10 codes Indicator: Number of trauma-related episodes with admission method equal to transfer from another hospital divided by Number of trauma-related episodes for all admission methods by acute trust (or hospital site if the data support) Data Handling Notes: 5214 June 2010

MTrauma5 – Percent of trauma episodes per acute trust Data Source: HES 2009/10 Data Details: Number of episodes by month by site where primary diagnosis (diag01) in list of trauma-related ICD10 codes (and first secondary diagnosis code (diag02), as required) Indicator: Number of trauma episodes per acute trust (or acute trust as the data support) divided by all episodes Data Handling Notes: 5314 June 2010

MTrauma6 – Length of stay for major trauma admissions by acute trust Data Source: HES 2009/10 Data Details: Compute bed days (discharge date minus admission date) for all episodes by month by site where primary diagnosis (diag01) and first secondary diagnosis (diag02), as required, in list of trauma-related ICD10 codes Indicator: LoS classification (0d, 1d, 2d, and >2d) – show total number of episodes by classification value for HES year 2009/ June 2010

MTrauma7 – Variation in total rehab bed days per site Data Source: HES for agreed trauma-related ICD10 codes Data Details: Compute rehab (identified by HRG codes) bed days (discharge date minus admission date) for all episodes by month by site where primary diagnosis (diag01) in list of trauma-related ICD10 codes Indicator: Mean (or median) rehab bed days by site (or acute trust as data support) for all episodes with trauma-related ICD10 codes by month Data Handling Notes: Compute national mean (or median) for benchmarking purposes 5514 June 2010

MTrauma8 – Ratio of rehab episodes / number of trauma episodes by site Data Source: HES for agreed trauma-related ICD10 codes Data Details: Number of episodes by month by site where primary diagnosis (diag01) in list of trauma-related ICD10 codes Number of rehabilitation episodes (identified by HRG codes) by month by site where primary diagnosis (diag01) in list of trauma-related ICD10 codes Indicator: Ratio of rehab trauma episodes to total number of trauma episodes Data Handling Notes: 5614 June 2010

DATA SPECIFICATIONS HIGH LEVEL NOTES  Sepsis 14 June

Sepsis1a: Number of deaths due to Sepsis in the North East Data Source: ONS, Death registration in England and Wales, Table 2: Deaths by age, sex and selected underlying cause Indicator: Number of Deaths relating to Septicaemia – ICD10 codes: A40-A41 Data Handling Notes: Data is available at the local authority level, mapped to Acute Trust using “Mapping tool - Local Authority (Single Tier & District, 354) to Acute Trust (152)” Ver 3 (07/04/2009). Jon White, Office of the Chief Analyst, Department of Health. 58

Sepsis1b: Number of deaths due to Sepsis in the North East per 100,000 Data Source: ONS, Death registration in England and Wales, Table 2: Deaths by age, sex and selected underlying cause ONS, Mid year Primary Care Organisation population estimates for Indicator: Numerator: Number of Deaths relating to Septicaemia – ICD10 codes: A40-A41 Denominator: Population per PCT Calculation: Numerator/Denominator * 100,000 Data Handling Notes: Data is available at the local authority level, mapped to Acute Trust using “Mapping tool - Local Authority (Single Tier & District, 354) to Acute Trust (152)” Ver 3 (07/04/2009). Jon White, Office of the Chief Analyst, Department of Health. 59

Sepsis1c: Number of in hospital deaths related to Sepsis in the North East Data Source: Hospital Episode Statistics (HES) 2009/10 Indicator: Number of in-hospital deaths relating to Septicaemia – Any Diagnosis = Septicaemia (in ICD10 codes: A40-A41) – Method of discharge = died : (dismeth = 4) 60

Sepsis2a: Number of ICU bed days for Sepsis related admissions Data Source: Hospital Episode Statistics (HES) 2009/10 Indicator: Number of ICU bed days relating to Septicaemia – HRG code = WA03V (Septicaemia with Major CC) or WA03X (Septicaemia with Intermediate CC) Data Handling Notes: Compute bed days (discharge date minus admission date) for all episodes by Trust where HRG is WA03V or WA03X 61

Sepsis2b: Number of bed days for all Sepsis related admissions Data Source: Hospital Episode Statistics (HES) 2009/10 Indicator: Number of in-hospital deaths relating to Septicaemia – Any Diagnosis = Septicaemia (in ICD10 codes: A40-A41) Data Handling Notes: Compute bed days (discharge date minus admission date) for all episodes by Trust where any diagnosis is Septicaemia 62

Sepsis3: Cost of Sepsis related admissions Data Source: Hospital Episode Statistics (HES) 2009/10 Indicator: Number of in-hospital deaths relating to Septicaemia – Any Diagnosis = Septicaemia (in ICD10 codes: A40-A41) Data Handling Notes: ??? 63

DATA SPECIFICATIONS HIGH LEVEL NOTES  QIPP 14 June

QIPP1a – Number of emergency admissions per Acute Trust Data Source: HES 2009/10 Data Details: ADMIMETH = 21, 22, 23, 24 or 28 (emergency admission method), and CLASSPAT = 1 (patient classification) Indicator: a) Number of episodes resulting from emergency admissions by Acute Trust b) Proportion of emergency admissions versus all admissions by Acute Trust 6514 June 2010

QIPP1b – Proportion of emergency admissions versus all admission by Acute Trust Data Source: HES 2009/10 Data Details: ADMIMETH = 21, 22, 23, 24 or 28 (emergency admission method), and CLASSPAT = 1 (patient classification) Indicator: a) Number of episodes resulting from emergency admissions by Acute Trust b) Proportion of emergency admissions versus all admissions by Acute Trust 6614 June 2010

QIPP2a – 28d emergency re-admission rate per Acute Trust Data Source: NHS Comparators Data Details: Data is taken from NHS Comparators, Provider View – Across Secondary Care – Emergency Readmissions within 28 Days of Discharge See for more detailed indicator definitionhttps:// June 2010

QIPP2b – Proportion of 28d emergency re-admissions per Acute Trust vs all emergency admissions Data Source: NHS Comparators HES 2009/10 Data Details: NHS Comparator Data is taken from NHS Comparators, Provider View – Across Secondary Care – Emergency Readmissions within 28 Days of Discharge See for more detailed indicator definitionhttps:// June 2010

QIPP3 – Emergency Length of Stay per site Data Source: HES 2009/10 Data Details: ADMIMETH = 21, 22, 23, 24 or 28 (emergency admission method), and CLASSPAT = 1 (patient classification) Compute LoS = discharge date – admission date for each episode Indicator: Frequency counts of 1d, 2d, and >2d LoS by Acute Trust Data Handling Notes: Create Los categories of 1d, 2d, and >2d 6914 June 2010

QIPP4 – Ambulatory care sensitive as a % of admitted cases per site Data Source: HES 2009/10 Data Details: CLASSPAT = 1 Primary diagnosis (diag01) in agreed list of ICD10 codes Indicator: Number of ACS admissions (based on diag01) divided by total admissions by Acute Trust Data Handling Notes: 7014 June 2010

DATA SPECIFICATIONS DETAILED NOTES 71