Day Surgery Performance -Where to find it Overview Currently available data on Day Surgery Using data to improve performance Using data to drive innovation Mark Skues, Immediate Past President Editor in Chief, Ambulatory Surgery Email: Mark.Skues@nhs.net Day Surgery is a pathway Incremental improvements matter Diagnostics GP Surgical OPD Preop assessment Day Surgery Waiting List Admission and Surgery Inpatient Waiting List Day Unit Post-op Unan$cipated Discharge Recovery overnight admission Inpatient / Short Stay Unit Immediate Postoperative support Capacity Utilisation Booking Choice of suitable procedures Productivity How do trusts (and we?) compare? Comparisons: Day Case Rates England Scotland Wales Laparoscopic Cholecystectomy 48% 23% 40% Inguinal Hernia Repair 71% 64% 56% Subacromial Decompression 67% 49% 57% Tonsillectomy 53% 32% 1% Ops for female incontinence 50% 60% 24% Bri$sh is: England Wales Northern Ireland Scotland Review of the Year, BADS ASM, 2014 1
England Influences on data reporting The BADS Directory of Procedures Better Care Better Values website Payment by Results and Best Practice Tariff The BADS Directory of Procedures Audit Commission Basket of 25 Procedures Orchidopexy Inguinal hernia repair Anal Fissure Lap Cholecystectomy TURBT Carpal Tunnel Release Arthroscopy of Knee Removal of metalware Squint correction Tonsillectomy MUA # Nose D&C, Hysteroscopy Termination of pregnancy (2000) Circumcision Excision of breast lump Haemorrhoidectomy Varicose veins Dupuytren s contracture Ganglion excision Bunion operations Cataract removal Myringotomy + Grommet Sub Mucous Resection Pinnaplasty Diagnostic Laparoscopy Reported in various publications Audit Commission Basket of 25 Procedures Orchidopexy Inguinal hernia repair Anal Fissure Lap Cholecystectomy TURBT Carpal Tunnel Release Arthroscopy of Knee Removal of metalware Squint correction Tonsillectomy MUA # Nose D&C, Hysteroscopy Termination of pregnancy (2000) Circumcision Excision of breast lump Haemorrhoidectomy Varicose veins Dupuytren s contracture Ganglion excision Bunion operations Cataract removal Myringotomy + Grommet Sub Mucous Resection Pinnaplasty Diagnostic Laparoscopy 2
The BADS Directory of Procedures BADS Procedure Directory Breast Surgery ENT General Surgery Gynaecology Head and Neck Ophthalmology Orthopaedic Surgery Urology Vascular Surgery Paediatric Surgery Emergency Surgery Medical Procedures 2006 2007 2009 2012 170 Procedures BADS Procedure Directory BADS Procedure Directory Some procedures may need longer recovery or observation times Others may required specialised equipment or training for Clinicians to achieve their full potential Achievement of these goals may require: Reconfiguration of day surgery lists Redesign of the clinical pathway Investment in appropriate technology Length of Stay OPCS Codes OPCS 4.6 codes Exclusions Office of Population Censuses and Surveys 2007-09 Version 4.4 2009-11 Version 4.5 2011-14 Version 4.6 2014- Version 4.7 A list of 7000 operation codes Alphanumeric, (eg J183 (+Site Code)) Laparoscopic Cholecystectomy = J18.3+Y75.2 HRG 4 is non comparable (granularity) 3
a 17/11/15 The National Dataset BADS DIRECTORY of PROCEDURES National Dataset Calendar Year 2013 2012 2014 National dataset for 2013 Septoplasty 80% should have the op as a daycase. In Calendar year 2013: The top 5% achieved 99% as d/c The top 25% achieved 84% as d/c The top 50% achieved 68% as d/c (In England) 2) England Better Care Better Value website Better Care, Better Value website www.productivity.nhs.uk Was run by NHS Institute (Disbanded) Then NHS Elect, until March 2015 Now NHSIQ (until March 2016) 4
Better Care Better Value website Better Care Better Value website Better Care Better Value website Septoplasty (Calendar Year 2014) % Day case 100 90 80 70 60 50 40 30 20 10 0 Trusts % Daycase Septoplasty (Calendar Year 2014) 100 90 80 70 60 50 40 30 20 Septoplasty 80% as daycase; 20% as overnight stay Day Case Performance in England Top 5% Top 25% Top 50% 2013 99% 84% 68% 2014 100% 88% 71% 10 0 Trusts 5
3) Best Practice Tariff for Day Surgery A differential (beneficial!) payment for day surgery care Admission, treatment and discharge in the same calendar day with day surgery management intent Approx 250 per patient (+ cost of an overnight bed) for 15 daycase procedures. Laparoscopic Cholecystectomy: Best Practice Tariff 2009: Day case: 1365 In-patient: 1365 For 2010-11: Day case: 1694 In-patient: 1369 Best Practice Tariff 2015 Breast Surgery: Mastectomy, SLNB, Axillary Clearance ENT: Tonsillectomy, Septoplasty, Mastoid Ops/Tympanoplasty Orthopaedics: Dupuytren s, Subacromial decompression, Bunion ops Gynaecology: Female incontinence surgery, O/P Hysteroscopy/Sterilisation Urology: Resection of Prostate, O/P Cystoscopy General Surgery: Laparoscopic Cholecystectomy, Hernia Repair Update for 2016 Tariff It is proposed that an additional 16 procedures be incentivised for Day Surgery Best Practice Tariff. Consultation document in August 2015; Multiple subspecialities Includes medical procedures Changes to target rates 6
Best Practice Tariff 2015 Breast Surgery: Mastectomy, SLNB, Axillary Clearance ENT: Tonsillectomy, Septoplasty, Mastoid Ops/Tympanoplasty Orthopaedics: Dupuytren s, Subacromial decompression, Bunion ops Gynaecology: Female incontinence surgery, O/P Hysteroscopy/ Sterilisation Urology: Resection of Prostate, O/P Cystoscopy General Surgery: Laparoscopic Cholecystectomy, Hernia Repair PEDW data Wales information Wales info Wales info Wales info Local Health Board or Totals for Wales How many Lap Choles were daycase in Wales in 2013-4? 7
17/11/15 How many Lap Choles were daycase in Wales? How many Lap Choles were daycase in Wales in 2013-4? OPCS FCE Emergencies Daycase Daycase % J181 10 1 2 22.2% J183 3971 370 1420 39.4% TOTAL 4071 371 1422 38.4% Daycase rate (%) =Daycase / (FCE Emergencies) Northern Ireland Scotland http://www.dhsspsni.gov.uk/index/statistics http://www.isdscotland.org/health-topics/hospital-care/ Operations-and-Procedures/ Not stra$fied by opera$ve procedure Scotland And finally.. Again, only stratified to speciality and health board but not individual procedure.. So, % Daycase for Breast Surgery for Ayrshire & Arran can be quoted.. 100 80 BADS is aware of the limitations of current data acquisition. Downloads from BCBV indicate the wide variation in daycase performance with a wide variety of operations 60 40 20 0 2009/10 2010/11 2011/12 2012/13 2013/14 8
Day case (%) 90 80 70 60 50 40 30 20 10 0 Q4 2014-5.. Variation Laparoscopic Cholecystectomy Trusts The BADS Top 10 Laparoscopic Cholecystectomy Inguinal Hernia Repair Tonsillectomy Septoplasty Female incontinence operations Therapeutic shoulder ops Bunion repairs Endoscopic Prostate resection Endoscopic resection of bladder lesion Simple mastectomy Why? Volume of procedures in England National variation in Day Surgery rates Uptake by PbR England for BPT incentivisation (All will be incentivised from April 2016) Check the BADS website to download a spreadsheet showing comparative performance for these operations) Day Surgery Performance Mark Skues, Immediate Past President Editor in Chief, Ambulatory Surgery Email: Mark.Skues@nhs.net -Where to find it 9