Long-stay patients methodology Published by NHS England and NHS Improvement July 2018 1
Document Title: Long-stay patients methodology Version number: 1.0 First published: 9 July 2018 Updated: Prepared by: Reducing Long Stay Patients Project Team Classification: OFFICIAL This information can be made available in alternative formats, such as easy read or large print, and may be available in alternative languages, upon request. Please contact the Project team at: nhsi.longstaysdashboard@nhs.net. 2
Contents Contents... 3 Summary... 4 Activity type... 4 Patient age... 4 Admission and LOS groups... 5 Trust type... 5 All days versus long-stay days... 5 Appendix... 6 Acute treatment functions... 6 3
Summary This document sets out the standardised definition and methodology for counting long-stay patients and bed days in SUS+ and HES, including the reason for each inclusion/exclusion applied. A long-stay patient can be defined as an adult patient who has occupied an acute bed for 21 days or longer. The methodology is: Acute activity only 1 18+ only 2 Excludes regular day and night attenders, day cases and zero length of stay (LOS) admissions Acute trusts only Count long-stay days only (ie Day 21 onwards). Activity type SUS data covers most activity types including maternity and mental health patients. However, the reasons for only including acute activity are: maternity beds are generally not available to be repurposed for other admissions, and long-stay maternity patients do not affect the flow from A&E mental health patients in a mental health trust can be separately identified by trust type (see Trust type below) mental health patients in acute trusts constitute less than 0.1% of acute trust patients mental health patients discharge needs will differ from other long-stay patients. Patient age All age groups are covered by SUS data. However, the reasons for restricting it to adult patients are: part of the interest in long-stay patients stems from the inter-relation between these patients and delayed transfers of care (DTOCs) DTOCs only apply to adults to maintain correspondence with DTOC, children are excluded. 1 For a full list of acute treatment functions, see Appendix. 2 Due to data quality issues, it is advised to include an upper age limit of 130. 4
Admission and LOS groups There are a several types of hospital admission. However, not all are relevant to long-stay patients. The definition has been restricted to overnight admissions because: most elective admissions are day-case admissions, and while these constitute a large volume of patients they do not contribute to the counts of bed days in recent years the number of zero LOS non-elective admissions has increased considerably as the concept of ambulatory emergency care has taken hold; such cases have been referred to as emergency day cases regular day and night attenders for example, for dialysis constitute a specific category of admission; as for day cases, such attenders will never be part of the 21+ days long-stay patient cohort and will not increase the bed-day count. Trust type There are several trust types, including acute, community, mental health and specialist. Each type will have different LOS patient profiles. For example, patients admitted to a mental health trust are more likely to have a long LOS than a patient admitted for elective care in an acute trust. For this reason, the long-stay metric applies only to acute trusts. All days versus long-stay days Patients only become long-stay patients after 21 days, so only count days 21 and onwards as long-stay days. 5
Appendix Acute treatment functions 100 General Surgery 101 Urology 102 Transplantation Surgery 103 Breast Surgery 104 Colorectal Surgery 105 Hepatobiliary & Pancreatic Surgery 106 Upper Gastrointestinal Surgery 107 Vascular Surgery 108 Spinal Surgery Service 110 Trauma & Orthopaedics 120 ENT 130 Ophthalmology 140 Oral Surgery 141 Restorative Dentistry 142 Paediatric Dentistry 143 Orthodontics 144 Maxillo-Facial Surgery 150 Neurosurgery 160 Plastic Surgery 161 Burns Care 170 Cardiothoracic Surgery 171 Paediatric Surgery 172 Cardiac Surgery 173 Thoracic Surgery 174 Cardiothoracic Transplantation 180 Accident & Emergency 190 Anaesthetics 191 Pain Management 192 Critical Care Medicine 211 Paediatric Urology 212 Paediatric Transplantation Surgery 213 Paediatric Gastrointestinal Surgery 214 Paediatric Trauma and Orthopaedics 215 Paediatric Ear Nose and Throat 216 Paediatric Ophthalmology 217 Paediatric Maxillo-Facial Surgery 218 Paediatric Neurosurgery 219 Paediatric Plastic Surgery 220 Paediatric Burns Care 221 Paediatric Cardiac Surgery 222 Paediatric Thoracic Surgery 223 Paediatric Epilepsy 241 Paediatric Pain Management 242 Paediatric Intensive Care 251 Paediatric Gastroenterology 252 Paediatric Endocrinology 253 Paediatric Clinical Haematology 254 Paediatric Audiological Medicine 255 Paediatric Clinical Immunology and Allergy Service 256 Paediatric Infectious Diseases 257 Paediatric Dermatology 6
258 Paediatric Respiratory Medicine 259 Paediatric Nephrology 260 Paediatric Medical Oncology 261 Paediatric Metabolic Disease 262 Paediatric Rheumatology 263 Paediatric Diabetic Medicine 264 Paediatric Cystic Fibrosis 280 Paediatric Interventional Radiology 290 Community Paediatrics 291 Paediatric Neuro-Disability 300 General Medicine 301 Gastroenterology 302 Endocrinology 303 Clinical Haematology 304 Clinical Physiology 305 Clinical Pharmacology 306 Hepatology 307 Diabetic Medicine 308 Blood and Marrow Transplantation 309 Haemophilia Service 310 Audiological Medicine 311 Clinical Genetics 313 Clinical Immunology and Allergy Service 314 Rehabilitation Service 315 Palliative Medicine 316 Clinical Immunology 317 Allergy Service 318 Intermediate Care 319 Respite Care 320 Cardiology 321 Paediatric Cardiology 322 Clinical Microbiology 323 Spinal Injuries 324 Anticoagulant Service 325 Sport and Exercise Medicine 327 Cardiac Rehabilitation 328 Stroke Medicine 329 Transient Ischaemic Attack 330 Dermatology 331 Congenital Heart Disease Service 340 Respiratory Medicine 341 Respiratory Physiology 342 Programmed Pulmonary Rehabilitation 343 Adult Cystic Fibrosis Service 344 Complex Specialised Rehabilitation Service 345 Specialist Rehabilitation Service 346 Local Specialist Rehabilitation Service 350 Infectious Diseases 352 Tropical Medicine 360 Genitourinary Medicine 361 Nephrology 370 Medical Oncology 371 Nuclear Medicine 400 Neurology 401 Clinical Neurophysiology 7
410 Rheumatology 420 Paediatrics 421 Paediatric Neurology 422 Neonatology 430 Geriatric Medicine 450 Dental Medicine Specialties 460 Medical Ophthalmology 502 Gynaecology 503 Gynaecological Oncology 650 Physiotherapy 651 Occupational Therapy 652 Speech and Language Therapy 653 Podiatry 654 Dietetics 655 Orthotics 656 Clinical Psychology 657 Prosthetics 658 Orthotics 659 Drama Therapy 660 Art Therapy 661 Music Therapy 662 Optometry 663 Podiatric Surgery 800 Clinical Oncology (Previously Radiotherapy) 810 Radiology 811 Interventional Radiology 812 Diagnostic Imaging 822 Chemical Pathology 834 Medical Virology 840 Audiology 920 Diabetic Education Service 0300 123 2257 enquiries@improvement.nhs.uk improvement.nhs.uk Publication code: IT 08/18 8