Inpatient, Day Case and Outpatient Activity

Emerging Statistics for Outpatient Procedures/Operations

Audit Scotland's report 'Outpatients Count' (1) highlighted the extent, complexity and heterogeneity of outpatient activity. In particular the report commented on the extent of clinical procedures now performed in outpatients, acknowledging the difficulties of capturing data routinely on this aspect of outpatients work.  From April 2003 the national reporting of surgical activity in outpatients has been required and ISD has been working with NHS Boards to develop full compliance nationally.

Collection of data on surgical procedures should be reported nationally on the person-based SMR00 return.  At this stage only a proportion of NHS boards have achieved extensive coverage and further work will be necessary by most boards before a complete account of all outpatient surgical activity can be made. 

An absence of reported activity does not necessarily imply that such operations are not carried out as it may simply reflect the relatively early stage of national reporting of outpatient operations and the incremental development of routine collection of these data.

The table below presents some emerging findings based on information supplied from the SMR00 database. The operations shown are Cataract Surgery, Cystoscopy, Endoscopy of upper/lower gastrointestinal (GI) tract, Endoscopy of Respiratory tract and Myringotomy. These operations are each illustrations of the type of operation/procedure that is now being performed in outpatients where previously they would have been carried out as day cases or inpatients.

On the basis of these provisional findings, comparisons by setting for each of the procedures show that in 2006/07:

• 66% of Cataract Surgery at NHS Grampian was reported as being performed in an outpatient setting.  In all other boards day case remains the more common approach.
• NHS Borders reported that 78% of Cystoscopies were performed in an outpatient setting.  NHS Ayrshire & Arran, Tayside and Fife also reported that over 60% of their Cystoscopies were performed in an outpatient setting. 
• 55% of Upper GI Endoscopies were reported to have taken place in an outpatient setting at NHS Forth Valley.  NHS Lothian and NHS Borders reported 51% and 47% respectively.
• NHS Forth Valley reported that 74% of Lower GI Endoscopies were performed in an outpatient setting.  The figure for NHS Lothian was 68%.  
• NHS Borders, Fife, Dumfries & Galloway and Grampian all reported that over 50% of Respiratory Endoscopies were performed in an outpatient setting.
• NHS Fife reported that 76% of Myringotomies were performed in an outpatient setting.  The figure for NHS Lothian was 58%.

Procedures recorded as being performed in an outpatient setting as a percentage of total outpatient, inpatient and day case activity
(e.g. cataract procedures reported as being carried out  in  an outpatient setting as a percentage of total inpatient, daycase and outpatient cataract procedures)

Full data - including outpatient, day case and inpatient numbers (March 2003- March 2007) now available via the excel link.

Sources: ISD SMR00 and SMR01
P The data shown is highly provisional and subject to change and caution should be exercised in their interpretation.

Definitions

Operations and procedures are classified using the Office of Population Censuses & Surveys 4th Revision
Classification of Surgical Operations and Procedures (OPCS4).  The following OPCS4 definitions apply: 

• Cataract surgery^(*) OPCS4 C71-C75
• Cystoscopic procedures OPCS4 M28-M30 M42-M45 M76-M77 M32.1-M32.3 
• Endoscopy of upper GI tract OPCS4G14-G19 G42-G45 G54-G55 G64-G65 G79-G80 
• Endoscopy of lower GI tract OPCS4 H20-H28 H68-H70
• Endoscopy procedures on Respiratory tract OPCS4 E24-E25 E34-E36 E48-E51 E62 E63
• Myringotomy OPCS4 D15 D20.2-D20.3

(*) Inpatient/day case data (SMR01) routinely capture a diagnostic component in the definition of cataract surgery but this is not possible on the SMR00 database because the recording of diagnosis is not mandatory. For consistency with SMR00 recording, the inpatient/day case activity above excludes the diagnostic component for cataract surgery.

For further information on procedures/operations carried out in NHSScotland, including provisional outpatient data at national level, click here .

(1) AUDIT SCOTLAND. Outpatients count: results of a census on outpatient activity. Published in Aug 2003, ref AGS/2003/6. ISBN 1904651062.

Main contact: Patient Team

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