http://www.isdscotland.org/ Quality Improvement Health statistics Tue, 24 Apr 2012 01:00:00 GMT Tue, 24 Apr 2012 01:00:00 GMT http://www.isdscotland.org/rss ISD Scotland NSS.isdexternalwebsite@nhs.net (ISD Web Team) NSS.isdexternalwebsite@nhs.net (ISD Web Team) http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#673 These data show that hospital mortality across Scotland is reducing over time.A single high quarterly HSMR figure is not sufficient evidence of an individual hospital providing poor quality of care or unsafe services, but should be used as a trigger for further investigations. Tue, 28 Feb 2012 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#673 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#643 These data show that hospital mortality across Scotland is reducing over time.A single high quarterly HSMR figure is not sufficient evidence of an individual hospital providing poor quality of care or unsafe services, but should be used as a trigger for further investigations. Tue, 29 Nov 2011 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#643 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#892 Main points for complaints to NHS Boards and their Divisions, 2010/11:After a gradual rise in the number of complaints from 1999/00, this figure has been relatively stable in recent years (7,123 in 2009/10 and 7,055 in 2010/11).Of the 7,055 complaints made about Hospital & Community Health Services in 2010/11, 5,217 (74%) related to the Hospital acute service group.The percentage of complaints acknowledged within the national target timescale of three working days from receipt was 95.8%, while the percentage of complaints dealt with within the national target of 20 working days was 67.6%.The most prevalent issue raised in 2010/11 was ‘Treatment’ (36%), followed by ‘Staff’ (34%) and ‘Environment/domestic’ (11%).In 2010/11, 28% of complaints were fully upheld, 33% were partially upheld and 37% were not upheld.Main points for Family Health Services, 2010/11:The number of complaints about Family Health Services in 2010/11 was 3,233. Dental complaints decreased by 21% in 2010/11, while Medical complaints continued to rise.In 2010/11 84% of Family Health Service complaints related to ‘Medical’ services.Main points for Special Boards, 2010/11The total number of complaints relating to the Special Health Boards; National & Support organisations and the Scottish Health Council was 812 in 2010/11. As part of this, Scottish Ambulance Service complaints decreased by 22% (374), Scottish National Blood Transfusion Service complaints remained at a similar level to the previous year (256) and NHS24 complaints reduced by 37% (71). Tue, 25 Oct 2011 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#892 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#633 In 2010 there were 418 patients who received ECT, relating to 522 episodes of care.The most prevalent primary diagnosis for patients starting an episode of ECT was a depressive episode without psychosis (43%).The most common indication for treatment was medication resistance to antidepressants (63%). A total of 9% of patients received ECT as a life-saving procedure.The majority (65%) of episodes involved patients who were capable of giving informed consent.Overall, 75% of patients showed an improvement after an episode of ECT.The proportion of patients who showed an improvement after an episode of ECT was slightly higher for patients without capacity (i.e. unable to give informed consent) (80%), than with capacity (73%), possibly reflecting more serious illness in the former group.The use of continuation or maintenance ECT remains low, with only 18 episodes being recorded in 2010.The most frequently recorded side effect was headache (22%).Critical incidents occurred in 12 (0.3%) treatments. Tue, 25 Oct 2011 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#633 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#636 Incidence: The incidence of new patients starting RRT each year has fluctuated over the past ten years. There appears to be a decreasing trend in the number of incident patients over the past five years, this is due to a decrease in the number of incident patients aged = 65 years.Prevalence: On 31 December 2010 there were 4368 patients receiving RRT. Of these 50% of patients had a functioning kidney transplant, 43% were being treated with haemodialysis (HD) and 7% with peritoneal dialysis (PD). In contrast to numbers of new patients starting RRT, the numbers of prevalent patients is still rising.Life expectancy: The life expectancy of patients receiving RRT is shorter than that of the general population. The survival of patients is influenced by their age at the time of starting RRT and also by their primary renal diagnosis (PRD). The median survival for a patient starting RRT over the past 25 years aged 45 to 64 years with glomerulonephritis was 8.1 years. In contrast the average life expectancy of males from the general population aged 45-64 years is 25.1 years.Kidney transplantation: 181 patients received a kidney transplant in Scotland in 2010. 27% of kidney transplants performed between 2006-2010 were from live kidney donors. The median age at transplantation in the same time period was 46 years. Kidney transplants performed in 2009 had a 96% one year graft survival and a 93% one year patient survival.Vascular access for HD: In May 2011, 75.6% of HD patients had an arteriovenous fistula which is regarded as the best form of vascular access for HD. The remaining 24.4% were using central venous catheters which are prone to infection. The use of arteriovenous (AV) access for HD patients has not improved over the last five years, however there are significant differences in the utilisation between renal units. Tue, 25 Oct 2011 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#636 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#894 There are 93 clinical indicators within the Surgical Profile, arranged according to 8 surgical specialty groupings, showing hospital and health-board variations in mortality, volume of procedures performed, length of stay and readmissions.The analysis is coupled with a formal process of dialogue with each NHS Board about how they interpret and use the data locally.Each of the 15 NHS Boards have provided an initial response to their Surgical Profile.The Surgical Profile aims to stimulate reflection that may contribute towards improvements in patient care; NHS Boards are asked to respond to ‘outliers’ regardless of whether their rate is high or low.Larger NHS Boards may have a greater number of outliers to review simply due to the higher number of hospitals within their board areas; also some indicators are not applicable to smaller boards.In addition to board and hospital comparisons the surgical profile provides access to national trends in mortality and volume of procedures performed.The project team is working with a number of groups with national remits in order to try and better understand these data.Between 2005 and 2010 crude 30-day mortality has fallen from 0.41% to 0.23% following elective surgical admissions and from 4.11% to 2.11% following non-elective admissions. Tue, 25 Oct 2011 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#894 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#599 Delayed discharges:Delays continue to increase (although this may be partly due to improvements in the data collection method). The main reason for both ICU and HDU delays is delay in obtaining downstream beds. Unit level data is available for the first time in figures 15 and 16. One hospital has 3 units who are above 3 standard deviations and we would advise that this is reviewed locally.Out of hours discharges:Out of hours discharges remain around 15%, reasons may be due to overall shortage of unit beds and difficulties in finding a downstream bed.Source of Admission: The number of patients admitted to ICU/Combined Units directly from the Emergency Department now exceeds that admitted from wards. This may be that critically ill patients are being recognised and treated quicker.Level 0 Patients in Critical Care: 1% of ICU/Combined unit episodes and 6% of HDU episodes are Level 0. Level 0 is defined as a patient where adequate monitoring could be provided in a general ward. SICSAG advise that units with a high proportion of level 0 patients review this locally.ICU mortality continues to improve: The Scottish ICU Standardised mortality ratio is 0.86 – a continuation of the downward trend seen over the last ten years.Quality improvement measures/processes: Appendix 2 and 3 show that quality improvement measures continue in all units. Tue, 30 Aug 2011 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#599 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#607 These data show that hospital mortality across Scotland is reducing over time.A single high quarterly HSMR figure is not sufficient evidence of an individual hospital providing poor quality of care or unsafe services, but should be used as a trigger for further investigations. Tue, 30 Aug 2011 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#607 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#585 The five key NHS QIS quality standards for stroke are:At least 60% of patients should be admitted to a Stroke Unit on day of admission (Day 0) and 90% by the day following admission (Day 1) to hospital. In 2010 39% (2009 - 37%) admitted to a Stroke Unit on Day 0 and 63% (2009 - 61%) by Day 1.All patients should have a swallow screen on the day of admission. In 2010 61% (2009 - 62%) of patients had a swallow screen recorded on the day of admission.At least 80% should have a brain scan on the day of admission. In 2010 52% (2009 - 49%) of patients had a brain scan on the day of admission.All patients with ischaemic stroke should receive aspirin on the day of admission or the day after unless contraindicated. In 2010 73% (2009 - 68%) of ischaemic stroke patients received aspirin by the day after admission.80% should be seen within 7 days from referral. In 2010 82% (2009 - 81%) of patients seen in neurovascular clinics were seen within 7 days. Tue, 28 Jun 2011 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#585 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#567 These data show that hospital mortality across Scotland is reducing over time.A single high quarterly HSMR figure is not sufficient evidence of an individual hospital providing poor quality of care or unsafe services, but should be used as a trigger for further investigations. Tue, 31 May 2011 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#567 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#739 These data show that hospital mortality across Scotland is reducing over time.A single high quarterly HSMR figure is not sufficient evidence of an individual hospital providing poor quality of care or unsafe services, but should be used as a trigger for further investigations.The process was not designed to compare hospitals or identify “outliers”.The model does not adjust for all clinically relevent characterstics that define risk in the patient case mix of individual hospitals over time. Features such as the type of hospital, extent of provision of palliative care or the balance between elective and non-elective activity need to be understood before a meaningful conclusion can be drawn from direct comparisons between different hospitals. Tue, 22 Feb 2011 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#739 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#759 The incidence of new patients starting renal replacement therapy (RRT) for established renal failure (ERF) each year has fluctuated over the past 10 years between 101 per million of the population in 2001, up to 111 in 2007. 104 patients per million population started RRT for established renal failure (ERF) in 2009.4278 patients were receiving RRT for ERF on 31 December 2009. Of these, 49% of patients had a functioning kidney transplant, 44% were being treated with haemodialysis (HD) and 7% with peritoneal dialysis (PD). In contrast to the number of new patients starting RRT, the number of prevalent patients continues to rise annually.209 patients received a kidney transplant in Scotland in 2009. 27% of kidney transplants performed between 2005 and 2009 were from live kidney donors. Kidney transplants performed in 2008 had a 93% 1 year kidney transplant survival and a 99% 1 year patient survival.The life expectancy of patients receiving RRT is shorter than that of the general population. The survival of patients is influenced by their age at the time of starting RRT and also by their primary renal diagnosis (PRD). The median survival for a patient aged 45 to 64 years at the start of RRT with glomerulonephritis is 7.7 years. The median survival of a patient in the same age group with a PRD of diabetic nephropathy is 2.9 years. In contrast: the life expectancy of a male from the general population aged 55 years is 24.2 years. There is a trend of significant improvement in two year survival for patients starting RRT over the past 10 years. Tue, 30 Nov 2010 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#759 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#756 308,910 emergency attendances were recorded at the 20 participating hospitals between 2nd March and 31st May 2009, 1.7% (5285) of which developed signs of sepsis within two days of attendance. The median duration of stay in hospital was seven days. Most patients were cared for within a ward, however 14% were admitted to a Critical Care unit within two days of attendance. The median length of stay for patients within a Critical Care unit was three days. Early Warning System (EWS) charts were commenced for 71% of patients within two hours of attendance. Where the EWS chart indicated the need for review by senior nursing / medical staff, documented confirmation that this had occurred was present in 91% of cases. 34% of patients with sepsis also developed signs of severe sepsis within two days of attendance. The overall mortality for patients who met the criteria for sepsis was 14%. For patients who met the criteria for severe sepsis, mortality was 24%. Tue, 30 Nov 2010 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#756 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#755 These data show that hospital mortality across Scotland is reducing over time. A single high quarterly HSMR figure is not sufficient evidence of an individual hospital providing poor quality of care or unsafe services, but should be used as a trigger for further investigations. The process was not designed to compare hospitals or identify 'outliers'. The model does not adjust for all clinically relevent characterstics that define risk in the patient case mix of individual hospitals over time. Features such as the type of hospital, extent of provision of palliative care or the balance between elective and non-elective activity need to be understood before a meaningful conclusion can be drawn from direct comparisons between different hospitals. Tue, 30 Nov 2010 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#755 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#762 The number of hip and replacements continued to rise in 2009. There were 7,168 hip replacements, 6,884 knee replacements, 986 hip revisions and 567 knee revisions. Shoulder and finger arthroplasties also continued to increase (405 and 77 respectively).The length of stay for hip replacements continued to fall year on year. It has decreased from an average (mean)of 10.3 days in 2001 to 6.2 days in 2009. The length of stay for knee replacements has decreased from 10.1 days in 2001 to 6.5 days in 2009.The rate of DVT/PE (1%) and mortality (0.4%) at 90 days after hip arthroplasty were at their lowest level ever. The rate of dislocation and infection within a year of hip arthroplasty did not differ greatly from recent years. Rates for infection, DVT/PE and deaths following knee replacement also remained similar to recent years.In this annual report, for the first time, revision rates are reported at 1, 3 and 5 years following primary hip and knee replacement. Revision rates at 1 and 3 years for hip and knees were lowest in 2005. There has been a small increase in revision rate since then. There was less variation between boards for knee revisions at 1 year compared to hip revisions. This may be due to a more uniform design of knee prostheses compared to hip prostheses. Tue, 26 Oct 2010 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#762 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#763 In 2009 the total number of inpatient deaths occurring whilst under the care of a surgeon and reported to SASM was 3,310. By 1st July 2010, 78% (2,583) of these deaths had been audited. Of the 3,310 reported deaths, 51% (1,691) completed the full SASM peer review process. In 89% of cases where the patient had completed the full SASM process, no areas of concern or for consideration in relation to the patient's management were reported. Cases where concerns were raised that were deemed to have contributed to (1.8%) or caused (0.2%) the death of a patient were rare. The most commonly reported area of concern or for consideration was "Transfer should not have occurred / Inappropriate admission to a surgical ward". SASM believes that the best driver for change is local discussion and recommends that all surgical deaths are reviewed by hospitals at morbidity and mortality meetings. In 82% of all audited deaths that occurred in 2009, the case had either been discussed or was planned to be discussed at a morbidity and mortality meeting. Tue, 26 Oct 2010 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#763 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#764 In 2009, there were 483 episodes of ECT with 390 patients being treated. Although there has generally been a downward trend in the use of ECT, a slight increase in use was observed in 2009 compared to 2008 (444 episodes). Around three quarters of the ECT episodes that occurred in Scotland in 2009 involved patients who were capable of giving informed consent. The majority of patients undergoing ECT treatment do so because of a depressive episode, in relation to either a bipolar or a depressive disorder. Seventy-eight percent of patients with capacity and 85% of patients without capacity showed a definite improvement following ECT. Tue, 26 Oct 2010 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#764 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#769 The number of complaints for Hospital and Community Services has been relatively stable in recent years, with 7,123 complaints received in 2009/10.76.0% of complaints were dealt with within the national target of 20 working days in 2009/10.The number of complaints for Family Health Services was estimated at 3,515 in 2009/10, expected to represent an 11% increase when compared against 2008/09. Tue, 28 Sep 2010 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#769 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#778 The data suggest that hospital mortality across Scotland is largely reducing over time.No hospital had mortality which was significantly higher than predicted given the patients and conditions seen there and relative to the Oct 06 ? September 07 baseline.A single apparently high value of the HSMR is not sufficient evidence on which to conclude that a poor quality or unsafe service is being provided.There is variability (random variation) in the numbers of events observed by location and over time.  The smaller the group of patients at risk of dying, the greater the variability in actual deaths seen when measured over fixed periods of time.Inaccurate recording of information in hospital records, or errors in the coding of information, for example the main diagnosis, can lead to the over- or under-estimation of the number of deaths which would be expected for a hospital.  ISD seeks to avoid this by undertaking regular surveys of data quality in all NHS Boards and provides training in clinical coding. Tue, 31 Aug 2010 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#778 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#789 Significant out of hours workload: 44% of admissions to ICU and 30% of admissions to HDU occur between 8pm and 8am, reflecting the 24/7 nature of Critical Care.New measures: early discharges and readmission within 48 hours of discharge: Both early discharge and readmission within 48 hours can be a marker of insufficient resources, although this is not the only factor. It is recommended that units whose measures are above the norm, examine the reason for this. Delayed discharges and Out of hours discharges: Delays continue to increase (although this may be partly due to improvements in the data collection method). The main reason for both ICU and HDU delays is delay in obtaining downstream beds. Out of hours discharges remain around 15%, reasons may be due to overall shortage of beds or difficulties in finding a downstream bed. ICU mortality continues to improve: ICU Standardised mortality ratio has reduced to 0.84. (APACHE II methodology). H1N1 planning and preparation: Preparation and planning for pandemic influenza was a major excersise for Critical Care which will serve Scotland well for the future. Quality improvement measures/processes: Appendix 2 and 3 show that quality improvement measures have been adopted in all units. Tue, 27 Jul 2010 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#789 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#793 The trend analysis from 2005-2009 demonstrates that the percentage of stroke patients admitted to a Stroke Unit on Day 0 has increased from 28% to 37% and on Day 1 from 49% to 61%. There has also been a significant improvement in the number of patients admitted to a Stroke Unit at any time during their admission, an increase from 71% to 81%.The trend analysis from 2005-2009 demonstrates that the percentage of stroke patients receiving a swallow screen on the day of admission has increased from 47% to 61%.The trend analysis from 2005-2009 demonstrates that the percentage of stroke patients having a brain scan on the day of admission has increased from 27% to 49%. Tue, 29 Jun 2010 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#793 http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#802 The data suggest that hospital mortality in Scotland is reducing over time.Scottish HSMRs are not directly comparable to those produced by Dr Foster for English hospitals.A single apparently high value of the HSMR is not sufficient evidence on which to conclude that a poor quality or unsafe service is being provided.There is variability (random variation) in the numbers of events observed by location and over time.  The smaller the group of patients at risk of dying, the greater the variability in actual deaths seen when measured over fixed periods of time.Inaccurate recording of information in hospital records, or errors in the coding of information, for example the main diagnosis, can lead to the over- or under-estimation of the number of deaths which would be expected for a hospital.  ISD seeks to avoid this by undertaking regular surveys of data quality in all NHS Boards and provides training in clinical coding. Mon, 21 Jun 2010 09:30:00 GMT http://www.isdscotland.org/Health-Topics/Quality-Improvement/Publications/index.asp#802