Acute Activity

Statistical Publication Notice

29 September 2009

Acute Hospital Activity to 31 March 2008 (annual data) and to 30 June 2009 (quarterly data).

INTRODUCTION

KEY POINTS

• The total number of hospital discharges (episodes) has increased by 2.1% to 1,345,000 in the year ending March 2008 from 1,317,000 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.
• For patients aged 65 years and over admitted as an emergency, occupied bed days appear to have leveled off at around 2.8 million in recent years, up to the year ending March 2008.  This data may be subject to slight change in future releases.
• 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.
• 4,500,000 outpatients were seen at consultant clinics in the year ending March 2008, showing a slight increase of 0.3% when compared to year ending March 2007.  In 2007/08, 1,387,000 were new outpatient attendances, an increase of 1.5% from 1,365,000 in 2006/07.

INTERPRETATION

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 2.1% to 1,345,000 in  the year ending 31 March 2008 from 1,317,000 in year ending March 2007.
• The number of elective inpatient discharges (episodes) is 199,000 in 2008, a decrease of 3.1% from 205,000 in 2007.
• The number of emergency inpatient discharges (episodes) rose by 4.0% to 529,000 in 2008 from 508,000 in 2007.
• The number of day case discharges (episodes) is 403,000 in 2008, a decrease of 0.6% from 406,000 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 6.3% to 370,000 in quarter ending June 2009 from 347,000 in quarter ending June 2008.
• The total number of inpatient discharges (episodes) increased by 7.4% to 261,000 in quarter ending June 2009 from 242,000 in quarter ending June 2008.
• The number of day case discharges (episodes) in quarter ending June 2009 is 109,000, an increase of 3.5% from 105,000 in quarter ending June 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.
• 2007/08 incidence analysis shows that the top three diagnosis incidences are Diseases of the Digestive System; Symptoms, Signs and Ill Defined Conditions; and Injury and Poisoning, representing 16.2%, 13.7% and 10.8% 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 1,959 in the year ending 31 March 2008, a 4.6% 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 March 2009, 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.

• 4,500,000 outpatients were seen at consultant clinics in the year ending March 2008, showing a slight increase of 0.3% when compared to year ending March 2007.  In 2007/08, 1,387,000 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.
• The percentage of did not attends (DNAs) for new appointments increased from 10.1% in 2006/07 to 10.4% in 2007/08.

Quarterly Trends (new)

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

• 1,159,000 outpatients were seen at consultant clinics in the quarter ending June 2009, showing a decrease of 0.5% when compared to the same quarter in 2008.  In quarter ending June 2009, 369,000 were new outpatient attendances, a rise of 2.2% from 361,000 in same quarter in 2008.
• The percentage of did not attends (DNAs) for new appointments increased from 10.0% in the quarter ending June 2008 to 10.4% in quarter ending June 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 4,795 in the year ending March 2007 to 4,955 in 2008, a smaller increase than the previous year (4,516 in 2006).
• For patients aged 65 years and over admitted as an emergency, occupied bed days appear to have leveled off at around 2.8 million in recent years, up to the year ending March 2008.  This data may be subject to slight change 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 3,976 in the year ending March 2003 to 4,171 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 926 in year ending March 1999 to 1,307 in 2008.

Beds (revised)

• The average number of available staffed beds in acute specialties has increased slightly to 17,397 in the year ending March 2009, compared with 17,353 in 2008.
• The occupancy rate of acute beds has been fairly constant over the last ten years at between 80-82%.
• The average number of inpatient discharges treated per bed i.e. throughput; has increased slightly to 53.3 in the year ending March 2009, compared with 52.3 in 2008.

Nurse and AHP Activity (revised)

• 883,000 outpatients were seen at nurse led clinics for acute specialties in the year ending March 2009.  Of these, 150,000 were new attendances.
• 5,576,000 outpatients were seen at an allied health professional or other technical department in the year ending March 2009.  Of these, 1,608,000 were new attendances.  The most frequent service utilised by outpatients is Radiography services; 41% for total attendances and 59% for 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.

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

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

PRE-RELEASE ACCESS:

HISTORY OF THIS PUBLICATION:

Last Published: 26 May 2009
Next Due: 22 December 2009
Data Available Since: April 1997

Main contact: Matthew Armstrong

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