1. Unscheduled Care Analysis
Explore Discovery
Unscheduled Care Analysis
Using Discovery to identify variation among high Volume Non Elective Admissions for further study

2. Methodology
Identified variation of Non Elective Admission/bed day rates by HB of Residence in Discovery at Level 1. (Slide 4)
Investigated this further by specialty which is available at Level 2. (Slide 5)
Used this information to identify what the high volume diagnosis are that are contributing to the admission and bed day rates within the Consultant team dashboard. (Slide 8 and 9). Information is available by individual consultant.
Analysed referral rates by Age/sex (Slide 6) and also local authority and GP practice to see if the information identifies any obvious outliers (Slide 11 and 12)
Analysed Specialty spell Average LOS for specific diagnosis to identify any variation for a specific high volume diagnosis (Slide 10)

3. Summary – Admissions and Bed Day Rate: Key messages
In this example Emergency Admission Rate is 117 for this HB, Scottish Average is 108. Emergency Bed Day rate is 880, Scottish Average is 761 (per 1000 population) (Slide 4)
To meet peer UQ this HB would need to reduce emergency admissions by 28,000 and bed days by 240,000 (Slide 4, Impact Analysis tab)
Admission and Bed Day Rate information is available at a specialty level (Slide 5 and 7)
For this HB Residents, their non elective Admission Rate for all Specialties is higher than the Scottish average for the majority of ages (Slide 6)
5 most common diagnoses for emergency IP episodes are R10 (Abdominal and Pelvic Pain), J44 (Other COPD), R07 (Pain in Throat and Chest), J18 (Pneumonia) and N39 (Other Disorders of Urinary System). In Discovery users can filter by specialty/consultant, etc (Slide 9)
In this example, These 5 diagnosis accounted for 18% of Emergency IP episodic activity for this HB and Time period. (slide 9).

4. Discovery: Level 1 Overview – Effective Residence: Indicator Summary Tab
This Dashboard identifies the standardised rate for Emergency admissions/Unscheduled care This is standardised by Age and Sex at Level 1.
A specialty split is not available on this Dashboard but is available at Level 2.
The impact Analysis tab states by what the health board would need to reduce Non-elective Admissions and Bed Days to reach the UQ of their Peers

5. Discovery: Level 2: Admissions Residence: Specialty Admissions per 1,000 population residence
From the previous view, have proceeded to level two: Admissions Residence.
1. Selections made on the filters.
2. The bottom table identifies the crude admission rate by specialty, including Bed Day Rate. Note some grouped Admission Conditions are also provided.
3. Note this dashboard is based on Continuous IP Length’s of Stay. Specialty is taken from the discharging episode of the CIS, and type of admission is taken from the 1st episode of the CIS.
At Level 2 in Discovery data is crude, no Standardisation has been applied

6. Discovery: Level 2: Admissions Residence: Demographic tab Admissions per 1,000 population residence
1. Selections made on the filters.
2. From the radio buttons list at the right hand side of the column chart, select analysis. In this example the differences for Admission Rates By Age is shown, with a comparison against the peer rate. This is for all ‘specialties’, not individual specialties.
It can be seen that the Non Elective Admission Rate for this HB is generally higher than the peer average across all age groups.
3. Most dashboards are dynamic so selections made on one panel are reflected in the other panels

7. Discovery: Level 2: Admissions Residence: Impact Analysis Tab Admissions per 1,000 population residence
1. The Impact Analysis tab allows the user to compare Admission Rates (or Bed Day Rates)
2. by a range of indicators and if the user hovers over any of the Bars in the chart a tooltip will appear that identifies what is needed to do to reach the UQ rate of their peers. User can immediately identify which specialties vary from the peer average
3. If user selects (or multi-selects) any of the specialties on the Bar Graph the trend chart at the bottom will update to reflect these selections

8. Discovery: Level 2: Consultant Dashboard: Diagnosis Tab Consultant Summary: Diagnosis: (Note activity based on HB of Treatment)
In this dashboard the user can identify the most common diagnosis for the high volume (or any) specialties previously identified. NOTE information is episodic in this Dashboard.
1. User chooses specialty, the dashboard updates to show most common Diagnosis for this specialty.
2. Activity by Consultant and diagnosis is available
3. User can flick between Activity (Episode) and Bed days
Dashboard provides comparison between the User selection, the HB and Scotland. User can also select a consultant grouping and analyse activity this way. This may be useful for some consultants as their activity may be split between specialties.

9. Discovery: Level 2: Consultant Dashboard: Diagnosis Tab Consultant Summary: Diagnosis: (Note activity based on HB of Treatment)
1. If the User selects (or Multi-selects) any of the diagnosis’ on the bar chart the information on the other panels will update to reflect this. In this example J44 has been selected for Emergency IP ALL SPECIALTIES and the user can see the proportion at this NHS Board accounts for compared to all of Scotland’s Activity for this diagnosis and episode type.
2. Activity by Consultant and diagnosis updates to show responsible consultants activity for this Diagnosis
3. Selecting all specialties allows the user to focus on that specific Diagnosis no matter what specialty was recorded

10. Discovery: Level 2: Average LOS Spells: Diagnosis Tab (Note activity based on HB of Treatment)
1. Specialty Spell Average LOS information is also available split by Diagnosis. Selections made on the filters.
2. Then select appropriate Diagnosis chapter and sub chapter information as required
3. This refines the information that is shown on the bottom table. The user can now see the spells associated with Non Elective Admissions with a Diagnosis that goes to 4 digit ICD 10 codes. Monthly trend information is also available to identify if any changes have happened over time
This dashboard is dynamic so selections made on one panel are reflected in the other panels. Holding down ctrl while you click on different areas of the graph will allow the user to multi-select Chapters/sub chapters.
Based on this information the user can identify spell activity for the choices they have made. Specialty Spells have been calculated as an unbroken period of time that a patient spends within a specialty. A patient may change consultant or significant facility during a specialty spell.
Tool tips appear with further information when the user hovers over different areas on the graph

11. Discovery: Level 2 Local Authority Summary
1. Within the Local Authority Summary dashboard the user has the ability to get a breakdown for the patients by HB of Residence at Local Authority level in relation to the chosen indicator and specialty
2. Information is available as either a number or a rate.
3. Trend information is available that will highlight any changes over time
HB A LA 4

12. Discovery: Level 2 GP Summary Dashboard:- GP Activity Tab
The GP Cluster Summary Dashboard combines a number of indicator information that is available by GP practice.
Activity information is available as activity or as a rate per 1,000 of the GP population (based on latest GP List size)
In this dashboard activity is linked to the specific GP practice recorded at the time of the activity, no matter where this activity takes place or where the patient lives.
It can be seen that GP practices have a range of Emergency Bed day rates (per 1,000). Comparisons available by GP practice, GP Clusters, HB and Scotland.
Different charts are available including Trend information which can identified any changes over time .

13. Summary Information
Admission and Bed Day rate information is based on Health Board of Residence and is based on Continuous IP Stays)
Consultant Team Dashboard information is available at an episodic level and is based on HB of Treatment
Average LOS Spells are based on specialty spells which have been calculated as an unbroken period of time that a patient spends within a specialty. A patient may change consultant or significant facility during a specialty spell
Data from Discovery can be extracted into excel format if required.
Discovery can help benchmark activity and identify unwarranted variation.
Procedure/Diagnosis Information is based on the recorded Diagnosis Codes (ICD 10) and Procedure Codes (OPCS 4) for Hospital Activity.
The procedure diagnosis search tab in the Consultant Team Dashboard will search for words from the actual diagnosis or procedure descriptions.
User can identify procedures that have taken place for specific diagnosis, or vice versa diagnosis that have been linked to specific procedures.

14. 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.

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