Acute Activity

Statistical Publication Notice

30 March 2010

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

INTRODUCTION

KEY POINTS

• The total number of hospital discharges (episodes) has increased by 3.9% to 1,400,000 in the year ending March 2009 from 1,347,000 in 2008.
• There were 539,000 emergency inpatient discharges (episodes) and 428,000 day case discharges (episodes) in the year ending March 2009, an increase of 1.7% and 6.1% respectively on the previous year.
• Neoplasms (including cancer) were the most common main diagnosis for patients discharged from hospital in the year ending March 2009, accounting for 14.2% of all primary diagnoses.  The comparable figure for the year ending March 2008 was 14.1%.
• A total of 977,000 inpatient and day case procedures were recorded as being undertaken in NHS Scotland in 2009.
• 4,626,000 outpatients were seen at consultant clinics in the year ending March 2009, showing an increase of 2.8% when compared to year ending March 2008.  In 2008/09, 1,461,000 were new outpatient attendances, an increase of 5.3% from 1,387,000 in 2007/08.
• The numbers of inpatient and day case discharges in the quarter ending December 2009 show small increases when compared to the same quarter of the previous year.  Outpatient attendances show a slight decrease when comparing the same time periods.

INTERPRETATION

DETAILED FINDINGS

Inpatient/Day Case Activity

Annual Trends (revised)

It should be noted that figures for year ending 31 March 2009 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 3.9% to 1,400,000 in  the year ending 31 March 2009 from 1,347,000 in year ending March 2008.
• The number of elective inpatient discharges (episodes) is 203,000 in 2009, an increase of 2.1% from 199,000 in 2008.
• The number of emergency inpatient discharges (episodes) rose by 1.7% to 539,000 in 2009 from 530,000 in 2008.
• The number of day case discharges (episodes) is 428,000 in 2009, an increase of 6.1% from 403,000 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. 

• The total number of hospital discharges (episodes) increased by 1.7% to 360,000 in quarter ending December 2009 from 354,000 in quarter ending December 2008.
• The total number of inpatient discharges (episodes) is around 250,000 in quarter ending December 2009, an increase of 1.3% on the quarter ending December 2008.
• The number of day case discharges (episodes) in quarter ending December 2009 is 110,000, an increase of 2.6% from 107,000 in quarter ending December 2008.

Diagnoses (revised)

• The most common main diagnoses for patients discharged from hospital in the year ending March 2009 are Neoplasms; Symptoms, Signs and Ill Defined Conditions; and Diseases of the Digestive System, accounting for 14.2%, 13.1% and 13.0% of all main diagnoses respectively.
• 2008/09 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 16.1%, 13.6% and 10.4% 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 2,039 in the year ending 31 March 2009, a 2.0% increase from 1,999 in the year ending 31 March 2005.

Procedures and operations (revised)

• A total of 977,000 procedures were recorded as being carried out on inpatients and day cases in NHS Scotland in the year ending March 2009, a difference of 19.9% from 1,220,000 in 2008.  This difference is due to the fact that from the 1st April 2008, it was no longer mandatory to record interventions/procedures (such as imaging, injections, infusions, x-rays eyc) unless the patient is specifically admitted for this purpose.  For further details please refer to the following document: http://www.isdscotland.org/isd/files/CGMarch08No22.doc
• By excluding those codes which are no longer mandatory to record as a result of the change in clinical coding practice, it is possible to compare the number of inpatient and day case procedures undertaken on a like-for-like basis.  This shows an increase of 2.3% from 809,000 in 2008 to 827,000 in 2009.
   
  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 September 2009, 74% of all elective BADS procedures were carried out as day cases or outpatients, showing a steady increase from 69% 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.
• 94% of cataract operations were performed in a day case or outpatient setting in the year ending 31 March 2009, compared to 87% in 2005.
• 76% of BADS surgical procedures in the specialty of orthopaedics were performed in a day case or outpatient setting in 2009, an increase of 1% when compared to 2005.

Average length of stay (revised)

• The average length of stay for all inpatient admission episodes in the year ending March 2009 is 5.3 days, showing a steady year-on-year decrease from 5.9 days in 2005.
• 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 7.3 days between 2005 and 2009, whilst for non-routine admissions the average has reduced by almost 1 day from 4.5 to 3.8 days in the same time period.

Outpatient Activity

Annual Trends (revised)

It should be noted that figures for year ending 31 March 2009 may increase slightly in future releases.

• 4,626,000 outpatients were seen at consultant clinics in the year ending March 2009, showing an increase of 2.8% when compared to year ending March 2008.  In 2008/09, 1,461,000 were new outpatient attendances, an increase of 5.3% from 1,387,000 in 2007/08.
• The return to new ratio for outpatient attendances has decreased from 2.6 return outpatients seen for each new outpatient in 2000 to 2.2 in 2009.
• The percentage of did not attends (DNAs) for new appointments is similar in 2008/09 when compared to 2007/08 (10.3% and 10.4% respectviely).

Quarterly Trends (new)

• It should be noted that the quarterly figures include an element of estimation and are likely to change in future releases.
• 1,128,000 outpatients were seen at consultant clinics in the quarter ending December 2009, showing a decrease of 2.9% when compared to the same quarter in 2008.  362,000 were new outpatient attendances, a decrease of 1.4% from 368,000 in same quarter in 2008.  These figures may be revised in future publications and should be treated with caution.
• The percentage of did not attends (DNAs) for new appointments increased from 10.5% in the quarter ending December 2008 to 10.9% in quarter ending December 2009.

Multiple Emergency Admissions (revised)

From December 2009, data analysis for Multiple and All Emergency Admissions and Bed Days data is based on the date of discharge rather than the date of admission. This change has been made in order to provide more accurate, relevant and complete data, particularly in relation to bed days information.

• For patients aged 65 years and over admitted as an emergency, there were around 341,000 occupied bed days per 100,000 population in the year ending March 2009.  This is very similar to the rate in the year ending March 2005.
• 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 4,929 in the year ending March 2008 to 5,108 in 2009, a slightly bigger increase than the previous year (4,784 in 2007).
• The emergency admission rate per 100,000 population for patients aged under 25 years with 1 admission in a given year increased steadily from 3,885 in the year ending March 2004 to 4,174 in 2008.  There has been a slight decrease in this rate to 4,105 in the year ending March 2009.
• 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 948 in year ending March 2000 to 1,344 in 2009.

Beds (revised)

• The average number of available staffed beds in acute specialties has increased slightly to 17,384 in the year ending March 2009, compared with 17,339 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 52.4 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.
• 5,582,000 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 with 2.3 million attendances in total, of which 950,000 were new attendances (representing 41% of all AHP attendances and 59% of new AHP attendances respectively).

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

Ishbel Robertson
Senior Information Analyst
0141 282 2276
ishbel.robertson@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

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PRE-RELEASE ACCESS:

HISTORY OF THIS PUBLICATION:

Last Published: 15 December 2009
Next Due: 29 June 2010
Data Available Since: For activity and beds information, some trends are available from April 1997.

Main contact: Matthew Armstrong

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