1. Hospital inpatient data James Hebblethwaite

2. Acknowledgements This presentation has been adapted from the original presentation provided by the following contributors: –Roy Maxwell SWPHO –Dr Richard Wilson Sandwell PCT –Kirsty Smith EMPHO

3. Learning objectives What is hospital inpatient data Differences between HES and SUS How HES and SUS are used in practice

4. What is HES / SUS ? Information is stored as a large collection of separate records - one for each period of care. Each record contains a wide range of information about an individual patient admitted to an NHS hospital. For example:- clinical information about diagnoses and operations patient information such as age group, gender and ethnic category administrative information, such as time waited and date of admission geographical information on where the patient was treated and the area in which they lived. A full list of variables collected and their definitions can be found within the Hospital Episodes Statistics Data Dictionary (Department of Health)

5. HES and SUS HES has a time delay, so probably all data are included Will not change Better for research rather than real time monitoring SUS is a live system, updated as per local arrangements, continually changing Therefore data from some trusts might not be complete – need to check you have all you expect Most private care missing from both – a problem in some specialties

6. HES Safe Haven Public Health Observatories (PHO) are regional “safe havens” for HES. PHOs have access to an extract of HES data for their Region going back 10 years. There is HES analysis available on the LHO website by local authority and ward

7. Data Collection HES data for admitted patients, outpatients and A&E comes from the routine exchanges of information between providers of healthcare for NHS patients in England and commissioners of the care. The data is submitted to the Secondary Uses Service (SUS), which, as well as forwarding it to the commissioners, also copies the information to a database.Secondary Uses Service At pre-arranged times during the year, SUS takes an extract from their database and sends it to HES. Data on SUS will continue to change, but HES data is fixed as it was when that particular extract was taken. HES then validates and cleans the extract, before deriving new items and making the information available in the data warehouse.

8. Limitations of data No patient names Only postcodes of residence Excludes (most) activity in private hospitals Restricted access to certain sensitive fields Consultant code GP code Boundary changes and population denominators (everybody ’ s nightmare, not just HES) Coding issues (e.g. ethnicity) – problem of all databases HES is not a live system Time lag - always 9-12 months behind 2007/2008 due around December 2008

9. What’s a record? (HES in more detail) At least one record for each patient’s stay in hospital (either day case or in-patient) A record reflects a patient’s period of care under a consultant, known as a consultant episode. A patient’s SPELL in hospital may comprise of more than one episode

10. Admissions vs. Episodes 1 Discharge 4 Episodes

11. practical uses of inpatient data

12. Seasonal variation

13. Trend over time

14. Comparative Directly age standardised hospital admission rates for accidents by local authority of residence in the East Midlands aged <15 2001/02 to 2005/06

15. Associations – e.g. deprivation Avoidable injury hospital admissions for children under 15 (2001/02 to 2005/06) and child poverty Index, local authorities

16. Main causes of accidental injury admissions (ages 0 to 14) 0.5% 0.8% 2.2% 0.4% 1.2% 4.5% 6.1% 8.4% 12.4% 18.7% 44.8% Accidents caused by fire Not elsewhere classified Contact with heat and hot substances Overexertion, travel, privation Other transport accidents Exposure to animate mechanical forces Accidental poisoning Other and Unspecified Road Traffic accidents Exposure to inanimate mechanical forces Accidental falls Main causes

17. Linkage: Equity

18. Linkage: Geography - presentational

19. Linkage: Geography - Access

20. Linkage: Readmissions

21. Learning outcomes Clearer understanding of what HES and SUS are Clearer understanding of appropriate use

22. HES/ SUS Quiz 1.When does a SUS/ HES datayear start? 2.What is the difference between an episode and a spell? 3.What two sets of clinical codes are used within SUS/ HES? 4.Give a strength of SUS data? 5.Give a strength of HES data? 6.Give an example of when you might want to link episodes. 7.What are the 2 main admission methods? 8.HES is not a live system, there is a time lag of _____.

23. HES/ SUS Quiz - Answers 1.1st April (financial years). 2.An episode is a patients period of care under one consultant and a spell is the patients entire stay in hospital. 3.ICD10 and OPCS4. 4.Timeliness 5.Better data quality, better comparability. 6.To analyse patient care throughout a spell in hospital, identify repeat spells, link to deprivation scores or postcodes etc 7.Elective and emergency. 8.HES is not a live system, there is a time lag of 9-12 months.