1. Emergency Care Data Set (ECDS)
Attendance, streaming, referrals and discharge 10th May 2018
Tom Hughes, ECDS Clinical Lead
Emma Fernandez, ECDS Project Manager
Andrew Clayton, Project Manager, NHS Digital
Saeed Daji, Operational Delivery Administrator, NHS Digital
Version: v1.0
The ECDS project is a collaborative project between the Department of Health, the Royal College of Emergency Medicine, NHS England, NHS Digital, NHS Improvement, NHS Providers and Public Health England. This document has been produced on behalf
of the ECDS Project Board in collaboration with the organisations listed above.

2. Send your comments to : ECDS@nhs.net
Before we start
We are recording the webinar for the benefit of others
Please send your comments and questions via the WebEx chat function to “everyone”
We’ll share the slides etc. after the meeting
Supporting documents are available on the ECDS web page (
This includes all webinars and downloads
Send your comments to :

3. On this afternoon’s call:
Attendance information
Crib sheets
Streaming and counting
Referrals
Discharge and follow up

4. Arrival

5. Accommodation status Scenario Correct coding (SNOMED-CT description)
Patient who is a foreign national or currently on holiday
Housed (finding)
Currently sleeping on a friends sofa
Patient refuses to disclose type of accommodation they usually reside in
Declines to provide accommodation details (finding)
Patient is unconscious on arrival with no other source of accommodation data
Unable to provide accommodation details (finding)
Student living in university accommodation in term time
Currently an inpatient in a drug rehabilitation service
Lives in hospital (finding)

6. Language
“What is [your] [the person’s] preferred language?”
Where a person is unable to consent for themselves (e.g. baby, child or who lacks capacity for any other reason) then the language of the person who is consenting will be recorded. For example a parent / guardian or someone with lasting power of attorney.

7. Attendance source Scenario Correct coding “I was referred by the GP”
Referred by member of Primary Health Care Team (finding)
“I was advised to attend by my GP’s practice nurse”
“I was advised to attend by NHS 111”
Referred by National Health Service service (finding)
“I was referred by my friend who is a practice nurse”
Self-referral to accident and emergency department (procedure)
“I consulted an online GP who advised me to attend”
Advised to attend accident and emergency department (situation)
“I was hit my leg playing football and my friends called an ambulance”

8. Four crib sheets are available
Reception staff guidance
Acuity / chief complaint [NB: Lorenzo]
Injury guidance
Common diagnoses
We are now able to post 10 copies of each per ED to you on request.
with:
Receiving person’s name
Address
How many ED’s it’s for (or one request per ED)
You may already have downloaded and printed local copies (
If there are spare copies and you need more, we will send these later.

9. Streaming guidance

10. Minimum ECDS Streamed data set
Patient Name
Patient Identification - NHS number / demographics
Arrival Date / Time (automatically entered)
Chief Complaint
Acuity
Discharge Status – service to which streamed
Departure Date / Time (automatically entered)
ECDS does not define streaming process
ECDS just defines the data collected, not how streaming occurs.
Only CC and acuity need collecting at point of streaming
The rest can be collected before or after depending on the model used.
[should the first person that the patient meets be clinical?]

11. Streaming options Streamed to primary care service / GP
Streamed to Urgent Care Centre
Streamed to Emergency Department
Streamed to Ambulatory Emergency Care service
Streamed to falls service
Streamed to frailty service
Streamed to mental health service
Streamed to pharmacy service
Streamed to dental service
Streamed to ophthalmology service
Streamed to Emergency Department only used when patient is streamed from UTC / type 2 (Specialist ED) / type 3 (MIU) / type 4 (Walk in Centre)

12. Capturing streaming in ECDS
Key points
Streaming = 1x complete ECDS episode
Streaming does not attract tariff
4 Hr standard start from first streaming
Reported through standard ECDS structure

13. Scenario A Alice falls breaking her femur and is taken to the ED.
Straightforward type 1 ED attendance
attracts tariff
four-hour standard applies.
Type 1 ED

14. Scenario B
Bob sustains a 5 cm laceration to his arm. Attends ED, streamed to co-located GP.
Two ECDS patient episodes
one streaming, attracts no tariff
one type 3, which attracts tariff.
Four-hour standard applies from the time of streaming
Stream to GP
Type 3 ED

15. Scenario C
Carol sustains a 5 cm laceration to his arm. Attends ED, streamed to adjacent UTC
Two ECDS patient episodes
one streaming, attracts no tariff
one type 3, which attracts tariff.
Four-hour standard applies from the time of streaming
Stream to UTC
Type 3 ED

16. Scenario D
Dan - 62-year-old man, presents to ED with a toenail infection, streamed to co-located UTC.
On arrival at the UTC it turns out he has a fever and diabetes and is streamed back to the ED.
Three ECDS episodes
Two streaming – attract no tariff
One treatment – attracts tariff
four-hour standard applies from first streaming
Stream to UTC
Stream to ED
Type 1 ED

17. Patient leaves

18. Absconders and walk outs
Register but leave before triage
No information can be gathered for chief complaint, acuity, diagnosis, referral
Discharge status: Left care setting before initial assessment (finding)
Discharge destination: Discharge to home (procedure)

19. Absconders and walk outs
Left after triage, before seen by clinician
Chief complaint, acuity entered
Nothing for diagnosis or Professional registration, investigation or treatment
Discharge status: Left care setting after initial assessment (finding)

20. Absconders and walk outs
Left after seen by clinician, before investigations/ treatment Chief complaint, acuity, diagnosis entered Nothing for investigation or treatment Discharge status: Left care setting before treatment completed (finding)

21. Referrals

22. Multiple referrals
Patient presents with abdominal pain, she is first referred to surgical on-call and then to on-call gynaecology team:
Referral to surgeons

23. Emergency care discharge summary

24. Emergency care discharge summary standard
The standard is practical and easy to implement as it was led and designed by the professionals who will be using it.
The project was commissioned by NHS Digital and managed by the PRSB, supported by the Royal College of Physicians Health Informatics Unit.

25. What will it mean for patients and professionals?
NHS Digital has developed technical standards so that the e-discharge summary can be implemented across the UK. It means GP systems can pull the information straight through from hospitals.
The standard NHS contract mandates providers to use PRSB headings to structure the discharge summary - from October 2018 they will be need to send structured and coded discharge summaries to GPs
Details on emergency visits will be available more quickly to GPs to improve on-going patient care.
Key information will directly enter the GP record, reducing the risk of transcription errors and improving the safety of care.  

26.
@ProfRecordsSB

27. General QA – your questions