1. Discovery in Action: Case Study
Using Discovery to identify variation for New Outpatient Referral Rates
Case Study:- Discovery use to support change in practice

2. Methodology
Identified variation of New Outpatient Referral Rates. (Slide 3)
Investigated this further by specialty. (Slide 4). Note possible to export this data from the Discovery Tool
Used this information to identify those specialties with the greatest potential productive opportunities compared to their Peers.
Analysed referral rates by age/sex (Slide 5) and also local authority and GP practice to see if the information identifies any obvious outliers (Slide 6 to 8)

3. Discovery: Level 1 Overview – Effective Residence: Indicator Summary Tab LA 4 Residents
This Dashboard identifies the standardised rate for New Outpatient Referral Rates This is standardised by Age and Sex at Level 1.
Overall for HB A their Standardised rate is 363 (per 1,000) V a Scottish Rate of 357.
LA 4 Residents Referral Rate is 361 (per 1,000), and are 4th out of 12 LA Peers.
Generally LA 4’s Referral Rate follows the Scottish Average monthly trend but is a bit lower
Specialty Split benchmarking available in the bottom bar Graph Can Quickly see that C8 Orthopaedics referral rate is higher than peer rate (grey dot).
Map hidden for presentational purposes
LA 1
LA 2
LA 3
LA 4
LA 5
LA 6
LA 7
LA 8
LA 9
LA 10
LA 11
There is also a within Board function that allows all LA within the HB be compared.

4. Discovery: Level 1 Overview – Effective Residence: Impact Analysis Tab LA 4 Residents
Although overall LA 4 residents are very close to their upper quartile peers, the specialty split below identifies Specialties that have potential productive opportunities to meet their peer UQ.
Trauma and Orthopaedics Rate 44 (per 1,000), peer average rate 34, Peer UQ rate 33. To meet Peer UQ rate required a reduction in T&O activity by 2,059 New OP appts.

5. Discovery: Level 2 New Outpatient Referral Rate: Demographic Tab LA 4 Residents:- Trauma and Orthopaedics Specialty
Age and Gender Split shows that for this Local Authority area the referral rate for working age patients is higher than there peers.

6. Discovery: Level 2 New Outpatient Referral Rate: GP Practice Tab LA 4 Residents:- Trauma and Orthopaedics Specialty
This Tab compares referral rates for the GP practices of LA 4 Residents.
If user hovers over dot further information appears. Scatter plot chart shows variation although there is no obvious relationship between Practice size and referral rate.
Table below provides activity, practice population size and Referral Rate information by GP practice.

7. Discovery: Level 2 GP Summary Dashboard:- GP Activity Tab Specialty:- Trauma and Orthopaedics:- New OP Activity Rates
The GP Cluster Summary Dashboard combines a number of indicator information that is available by GP practice.
Activity information is available as is rate information 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 referral rates (per 1,000). Comparisons available against GP Clusters, HB and Scotland.
User can flick between numbers and rates.
Trend information also can identified any changes over time .

8. Discovery: Level 2 Local Authority Summary
This Dashboard compares all residence indicators for a Local Authority compared against its HB and Scotland
User can flick between numbers and rates.
Trend information also available and can identify changes over time.

9. Case Study:- Discovery use to support change in practice:- Background
Background:- This HB had identified a capacity problem in a specific specialty.
HB established a project pilot to redesign the whole referral pathway, they needed GP support for this to help manage demand
They used the information available in Discovery as part of this analysis and summary Discovery information was also used to begin the conversation with the relevant GP practices. The ability to quickly access Discovery information to respond to queries was very helpful.
Whole Pathway for this specialty has been redesigned, establishment of
Consistent Vetting
Real time clinics
Nurse Advice for patients
Telephone advice available for GPs
Telemedicine project (based on work ongoing with the WI)

10. Case Study:-Using Discovery to help Monitor Impact
Key KPI’s to monitor impact
New Outpatient Activity/Referral Rate reduction over time
Ability to benchmark pilot area against other areas is in Discovery
Monitoring of New OP DNA rates
Expected reduction of DNA rates as more support is available in the community so only the most appropriate people are referred.
Monitoring of GP Referral Rates
To help assess uptake of additional redesigned support across all GP practices

11. Case Study:- Summary
Discovery Information complimented Local Information in the development of the Pilot.
Having quick access to data through Discovery helped engagement with the GP practices.
Ability to use Discovery to monitor trends and compare and contrast pilot areas with other areas to assess impact is useful.
For Further Information on this case study please contact the Discovery Team.

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