Page last updated: 26-MAY-2009

Acute Activity

ONS kitemarkStatistical Publication Notice

26 May 2009

Acute Hospital Activity (annual and quarterly data to 31 March 2009)

INTRODUCTION

This release contains information on acute hospital activity within NHS Scotland, illustrating current data and historic trends in secondary care provision and patient contact with the service. This information is published on a quarterly basis; ensuring the regular publication of new statistics and allowing previously released information to be revised using an increased and more complete set of data returns.
 
This release includes revised data for the year ending 31 March 2008 on inpatient, day case and outpatient activity. This data may be subject to slight change in future releases.
 
New data for the quarter ending March 2009 is also available along with revised data for previously published quarters. Quarterly figures are likely to be less complete than annual data and, as a result, imputation has been used to account for shortfalls in the quarterly data.
 
This release also contains revised data for multiple emergency admissions and average length of stay for routine and non-routine admissions; and new data for year ending March 2009 for beds, nurse and Allied Health Professional (AHP) outpatient activity.
 
In addition, information on the number of British Association of Day Surgery (BADS) surgical procedures performed in a day case or outpatient setting has been revised for the years ending March 2005 to September 2008; and new data for the year ending December 2008 is published. It should be noted that nationally collected information about procedures performed in an outpatient setting is a relatively new development and known to be incomplete. ISD Scotland is working with NHS Boards to develop full compliance nationally.
 
Please note that there are apparent anomalies between figures published from Acute Hospital Care, New Ways and Costs data sources.
 
The figures for elective admissions and new outpatients in the Acute Hospital Care publication are considerably higher than the equivalent information published on the New Ways Waiting Times web pages . This is largely due to the use of different definitions between the two sets of figures. For example, Acute Hospital Care information includes non-waiting list cases and non GP/GDP referrals, which do not form part of the published Scotland figures in 'New Ways'.
 
Figures for inpatient and day case activity in the Acute Hospital Care publication differ slightly when compared to the equivalent information released in the Costs web pages . This is largely due to the use of different definitions for the two sets of figures. For example, the Costs "acute" activity excludes the specialty of Geriatric Medicine and patients treated in Neonatal and Younger Physically Disabled Units, which differs from the "acute" activity that is published in the Acute Hospital Care pages. The Costs publication also excludes consultant-only transfers from the inpatient figures.
 
ISD Scotland is carrying out further detailed investigations into these differences.

KEY POINTS

  • The total number of hospital discharges (episodes) has increased by 2.0% to 1,343,000 in the year ending March 2008 from 1,316,000 in 2007.
  • Neoplasms (including cancer) were the most common main diagnosis for patients discharged from hospital in the year ending March 2008, accounting for 14.1% of all primary diagnoses.
  • 1,219,000 inpatient and day case procedures were carried out in NHS Scotland in 2008, an increase of 2.4% from 1,190,000 in 2007.
  • 4,497,000 outpatients were seen at consultant clinics in the year ending March 2008, showing a slight increase of 0.2% when compared to year ending March 2007. In 2007/08, 1,386,000 were new outpatient attendances, an increase of 1.5% from 1,365,000 in 2006/07.

INTERPRETATION

Outpatient, inpatient and day case activity data are collected across NHSScotland and are based on nationally available information routinely drawn from hospital administrative systems across the country. The principal data sources are the SMR00 (outpatients), SMR01 (acute inpatients and day cases) and ISD(S)1 (aggregate hospital activity) returns.
 
Data for the year ending March 2008 may be subject to change in future releases. SMR00 and SMR01 are considered to be 99% complete for the year ending March 2008. Further information on SMR data completeness is shown at the following link: http://www.isdscotland.org/isd/1607.html.
 
Quarterly figures up to and including March 2009 are likely to be less complete than annual data and, as a result, imputation has been used to account for shortfalls in the quarterly data.
 
Nurse and AHP outpatient information is still considered to be in development. Four full years of data are shown in this release but due to issues relating to data completeness, caution should be shown when making comparisons between years.

DETAILED FINDINGS

Inpatient/Day Case Activity
Annual Trends (revised)
It should be noted that figures for year ending 31 March 2008 may increase slightly in future releases. Information on outpatient activity is presented separately (below) and is not included within these figures.
  • The total number of hospital discharges (episodes) increased by 2.0% to 1,343,000 in the year ending 31 March 2008 from 1,316,000 in year ending March 2007.
  • The number of elective inpatient discharges (episodes) is 198,000 in 2008, a decrease of 3.3% from 204,000 in 2007.
  • The number of emergency inpatient discharges (episodes) rose by 4.4% to 532,000 in 2008 from 509,000 in 2007. · The number of day case discharges (episodes) is 400,000 in 2008, a decrease of 1.3% from 405,000 in 2007.
Quarterly Trends (new)
It should be noted that the quarterly figures include an element of estimation and are likely to change in future releases.
  • The total number of hospital discharges (episodes) increased by 2.4% to 346,000 in quarter ending March 2009 from 338,000 in quarter ending March 2008.
  • The total number of inpatient discharges (episodes) increased by 2.5% to 242,000 in quarter ending March 2009 to 236,000 in quarter ending March 2008.
  • The number of day case discharges (episodes) in quarter ending March 2009 is 104,000, an increase of 2.0% from 102,000 in quarter ending March 2008.
Diagnoses (revised)
  • The most common main diagnoses for patients discharged from hospital in the year ending March 2008 are Neoplasms; Symptoms, Signs and Ill Defined Conditions; and Diseases of the Digestive System, accounting for 14.1%, 13.3% and 13.2% of all main diagnoses respectively.
  • Analysis of eight long term conditions (based on main condition) showed that the hospital episode rate per 100,000 population for these conditions was 1,967 in the year ending 31 March 2008, a 4.2% decrease from 2,054 in the year ending 31 March 2004.
Procedures and operations (revised)
  • A total of 1,219,000 procedures were carried out on inpatients and day cases in NHS Scotland in the year ending March 2008, an increase of 2.4% from 1,190,000 in 2007.
  • The British Association of Day Surgery (BADS) has produced a directory of surgical procedures that contain aspirational goals for day surgery (including outpatient surgery). These cover around 40% of all surgical procedures. In the year ending December 2008, 69% of all elective BADS procedures were carried out as day cases or outpatients, showing a steady increase from 66% in the year ending March 2005. It should be noted that nationally collected information about procedures performed in an outpatient setting is a relatively new development and known to be incomplete. ISD Scotland is working with NHS Boards to develop full compliance nationally.
Average length of stay (revised)
  • The average length of stay for all inpatient admission episodes in the year ending March 2008 is 5.4 days, showing a steady year-on-year decrease from 6.0 days in 2004.
  • Inpatient admissions can be spilt into routine and non-routine admissions and both have seen a decrease in recent years. The average length of stay for routine admissions has fallen from 7.8 to 7.4 days between 2004 and 2008, whilst for non-routine admissions the average has reduced by almost 1 day from 4.7 to 3.9 days in the same time period.
Outpatient Activity
Annual Trends (revised)

It should be noted that figures for year ending 31 March 2008 may increase slightly in future releases.

  • 4,497,000 outpatients were seen at consultant clinics in the year ending March 2008, showing a slight increase of 0.2% when compared to year ending March 2007. In 2007/08, 1,386,000 were new outpatient attendances, an increase of 1.5% from 1,365,000 in 2006/07.
  • The return to new ratio for outpatient attendances has decreased from 2.6 return outpatients seen for each new outpatient in 1999 to 2.2 in 2008.
Quarterly Trends (new)

It should be noted that the quarterly figures include an element of estimation and are likely to change in future releases. 

  • 1,161,000 outpatients were seen at consultant clinics in the quarter ending March 2009, showing an increase of 2.9% when compared to the same quarter in 2008. In quarter ending March 2009, 364,000 were new outpatient attendances, a rise of 4.8% from 347,000 in same quarter in 2008.
  • The return to new ratio for outpatient attendances has decreased from 2.3 return outpatients seen for each new outpatient in the quarter ending March 2008 to 2.2, when compared to the same quarter in 2009.
Multiple Emergency Admissions (revised)
  • For patients aged 65 years and over who have had 2 or more emergency admission spells in hospital, the rate per 100,000 population has increased slightly from 4,806 in the year ending March 2007 to 4,976 in 2008, a smaller increase than the previous year (4,520 in 2006).
  • For patients aged 65 years and over admitted as an emergency, occupied bed days appear to have levelled off at around 2.8 million in recent years, up to the year ending March 2008. This data is considered to be provisional and may be subject to slight increase in future releases.
  • The emergency admission rate per 100,000 population for patients aged under 25 years with 1 admission in a given year has increased steadily from 3,970 in the year ending March 2003 to 4,210 in 2008.
  • The rate per 100,000 population for children aged 0 to 4 years who have had 2 emergency admission spells in hospital has increased over the last 10 years from 925 in year ending March 1999 to 1,302 in 2008.
Beds (new)
  • The average number of available staffed beds in acute specialties has increased slightly to 17,412 in the year ending March 2009, compared with 17,371 in 2008.
  • The occupancy rate of acute beds has been fairly constant over the last ten years at between 80-83%.
Nurse and AHP Activity (new)
  • 795,000 outpatients were seen at nurse led clinics for acute specialties in the year ending March 2009. Of these, 135,000 were new attendances.
  • 5,557,000 outpatients were seen at an allied health professional or other technical department in the year ending March 2009. Of these, 1,602,000 were new attendances.

Nurse and AHP outpatient information is still considered to be in development. Four full years of data are shown in this release but due to issues relating to data completeness, caution should be shown when making comparisons between years.


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MAIN CONTACTS:

Matthew Armstrong
Principal Information Analyst
0131 275 7487
Matthew.Armstrong@nhs.net

Kirsty Anderson
Senior Information Analyst
0141 282 2243
kirstyanderson@nhs.net

Ishbel Robertson
Information Analyst
0141 282 2276
ishbel.robertson@nhs.net

John Quinn
Information Analyst
0131 275 6573
j.quinn@nhs.net

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GLOSSARY:

Acute Hospital Care/Activity - includes services such as: consultation with specialist clinicians; emergency treatment; routine, complex and life saving surgery; specialist diagnostic procedures; close observation and short-term care of patients.  'Acute' hospital care excludes obstetric, psychiatric and long stay care services.
 
Average available staffed beds - the average daily number of beds which are staffed and are available for the reception of inpatients (borrowed and temporary beds are included).
 
Average length of stay - mean stay per episode (in days) experienced by inpatients within a specialty/significant facility etc over any period of time.
 
Day case - this is when a patient makes a planned attendance to a specialty for clinical care, and requires the use of a bed or trolley in lieu of a bed.
 
Discharge - a discharge marks the end of an episode of care.  Discharges include deaths and transfers to other specialties/significant facilities and hospitals.
 
Elective Admission - this is when the patient has already been given a date to come to hospital for some kind of procedure.
 
Emergency Admission - occurs when, for clinical reasons, a patient is admitted at the earliest possible time after seeing a doctor.
 
Episode - an SMR01 episode is generated when a patient is discharged from hospital but also when a patient is transferred between hospitals, significant facilities, specialties or to the care of a different consultant.
 
Inpatient - this is when a patient occupies an available staffed bed in a hospital and either; remains overnight whatever the original intention or is expected to remain overnight but is discharged earlier.
 
Non-routine admission - are those inpatients discharged following an emergency, unplanned admission (Includes emergency transfers).
 
Occupancy (%) - the percentage of available staffed beds that were occupied by inpatients during the period.
 
Occupied Bed - an occupied bed is an available staffed bed which is either being used to accommodate an inpatient or reserved for a patient on pass.
 
Outpatient - is a patient who attends (outpatient attendance) a consultant or other medical clinic or has an arranged meeting with a consultant or a senior member of his team outwith a clinic session. Outpatients are categorised as new outpatients or follow-up (return) outpatients.
 
Routine Admission - occurs when a patient is admitted as planned (Includes planned transfers).
 
Specialty - A specialty is defined as a division of medicine or dentistry covering a specific area of clinical activity.
 
Spell - a spell/care package is the healthcare provided usually in connection with a single condition. It may comprise several SMR episodes and cover one or more types of care, e.g. inpatient care, outpatient care, day patient care.
 
Further details are available in the NHSScotland Health & Social Care data dictionary:
http://www.datadictionaryadmin.scot.nhs.uk/isddd/9215.html
 
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PRE-RELEASE ACCESS

Under terms of the 'Pre-Release Access to Official Statistics (Scotland) Order 2008', ISD are obliged to publish information on those receiving Pre-Release Access ("Pre-Release Access" refers to statistics in their final form prior to publication). The standard maximum Pre-Release Access is five working days. Shown below are details of those receiving standard Pre-Release Access and, separately, those receiving extended Pre-Release Access.
 
Standard (five day) Pre-Release Access:
Scottish Government Health Department (Analytical Services Division)
NHS Board Chief Executives
NHS Board Communication leads
 
Extended Pre-Release Access:
Scottish Government Health Department (Analytical Services Division)
This extended Pre-Release Access is given to a small number of named individuals in the Scottish Government Health Department (Analytical Services Division). This Pre-Release Access is for the sole purpose of enabling that department to gain an understanding of the statistics prior to briefing others in Scottish Government (during the period of standard Pre-Release Access).
 
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HISTORY OF THIS PUBLICATION:

Last Published: 24 February 2009
Next Due: 25 August 2009
Data Available Since: For activity and beds information, some trends are available from April 1997.

 


Main contact: Email Matthew Armstrong