Inpatient, Day Case and Outpatient Activity
Multiple Admissions - Notes on Interpretation
Multiple Emergency Admissions and All Emergency Admissions are defined using a Continuous Spell of Treatment (CIS) in hospital. Probability matching methods have been used to link together individual SMR01 hospitals episodes for each patient, thereby creating "linked" patient histories. Within these patient histories, SMR01 episodes are grouped according to whether they form part of a continuous spell of treatment (whether or not this involves transfer between hospitals or even Health Boards).
Date of admission for the CIS and patient information (i.e. age, sex, area of residence, etc) is derived from the first episode of the CIS. The number of admissions is then calculated by counting the number of admissions within a financial year and area of residence / community health partnership (CHP). For example, if a patient was admitted as an emergency on 1st December 2004, 1st March 2005 and 1st May 2005, that would count as two admissions for financial year ending 31st March 2005 and 1 admission for financial year ending 31st March 2006 (1st April 2005 to 31st March 2006).
This methodology can lead to some confusion when interpreting the Multiple Emergency Admission tables. For example, adding 2+ admissions figures in neighbouring CHPs within an NHS Board may be expected to equal the 2+ admissions figures as shown in the Board level tables;
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Suppose patient X had 4 emergency admissions in financial year 2005. The first two admissions occurred when the patient resided in West Lothian CHP. The patient then moved house to Midlothian CHP before the next two emergency admissions. This would be counted as one 2+ admission in West Lothian CHP and one in Midlothian CHP, but only one 2+ admission for NHS Lothian as a whole.
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The above process also occurs when comparing NHS Scotland with NHS Boards / CHPs.
The interpretation of beddays can also be misleading. These are calculated by the taking maximum date of discharge and subtracting the minimum date of admission within a patient's continuous spell of treatment. As stated previously, the date of admission must lie between 1st April and 31st March of financial year X to calculate the number of admissions within that year. The date of discharge can be any date after 31st March of year X, so long as it is within 365 days from the date of admission. This can result in an apparent decreasing trend in beddays, particularly in the most recent years if the patient has not yet been discharged or their SMR01 discharge record has not yet been submitted:
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For example, if patient Y had been admitted on 1st February 2007 for an emergency operation for a Heart Bypass in Cardiac Surgery specialty, and transferred from that specialty to Rehabilitation Medicine on 1st March 2007, this CIS would be included in the tables. However, if the date of discharge from Rehabilitation Medicine was not until 1st December 2007 (still within 1 year from 1st February 2007), November's publication would not show this patient's true length of stay as the patient has not yet been discharged and their CIS not yet finished. Instead, it would show length of stay between 1st February and 1st March (28 days) rather than between 1st February and 1st December (303 days).
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The beddays and number of admissions for financial year ending 31st March 2007 can only be truly reflected once the SMR01 2007/2008 is 100% complete. In essence, with regards to timeliness of the completed SMR01 return, the true level of beddays for financial year 2007 may not be seen until publication in 2009.
The reason for a significant decrease in beddays for financial year 2007 appears to be due to long stay patients (but within 365 days) that have not yet been discharged. SMR01 completeness for financial year 2006/2007 is 98% complete as at 11th January 2008. To view our SMR completeness estimates, please click here .
For any further queries regarding this methodology, please contact patientteam@isd.csa.scot.nhs.uk
Patient Team
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