NHS Digital Data Release Register - reformatted

Civil Eyes Research Ltd

Project 1 — DARS-NIC-35166-B5Y7P

Opt outs honoured: N

Sensitive: Non Sensitive

When: 2016/09 — 2017/08.

Repeats: One-Off

Legal basis: Health and Social Care Act 2012

Categories: Anonymised - ICO code compliant

Datasets:

  • Hospital Episode Statistics Admitted Patient Care
  • Hospital Episode Statistics Outpatients
  • Hospital Episode Statistics Accident and Emergency
  • Hospital Episode Statistics Critical Care

Benefits:

Analyses are used by trust boards, directorates, clinical directors, managers and specialties to improve performance and quality and increase efficiency. Civil Eyes Research is acutely aware that its benchmarking activities need to result in demonstrable impact and improved value for the NHS. This is important for three reasons: to justify access to HES data, to demonstrate the value of the benchmarking services to NHS clients, and to improve the quality and efficiency of services for patients. To address this, all CER workshops within each benchmarking club are evaluated and delegates are asked to share action points following the meeting. A selection of actions is included below which show clear benefits for the NHS and patient outcomes – they are a sample of the action points documented. They show the role of the hospital clinician or manager and the action point arising from the benchmarking workshop and analysis. (A) Medical productivity within NHS organisations The selected action points have been grouped under the headings of efficiency, productivity, improved performance, and safety and quality outcomes Efficiency • Clinical Director, Theatres: High rate of inpatient surgery on day of admission rate achieved by a policy of operating at risk i.e. proceeding with theatre cases knowing that a bed will become available • Senior Nurse for Acute Medical Unit: Review acute take - how many patients could have been ambulatory • Manager, Peri-Operative & Critical Care: Good emergency stream for theatre activity has enabled low cancelled operation rate • Clinical Director: Consistent observation of and adherence to protocols for enhanced recovery has enable reduction in length of stay Productivity • General Manager Trauma & Orthopaedics: Introduction of virtual fracture clinics have enabled reduction in the outpatient follow-up rate • Cross Sectional Imaging Manager: Measuring the timing of peaks in patient demand linked with staffing resources • Clinical Director, Peri-Operative & Critical Care: Push for the proper review of surgical resource to understand how we get to 95% utilisation • Directorate Manager: Use PA and job planning to re-set specialty/service requirements • Clinical Lead on Obstetrics & Gynaecology: Consider grade mix of midwives • Speciality Manager: Introduction of colorectal nurse practitioner role for enhanced productivity • Business Manager, Trauma & Related Services: Examine productivity / throughput - number of cases per list Improved performance • Service manager: Looked at management of pneumonia patients • Service manager, Acute Medicine & Care of the Elderly: Introduced weekly statements of patients staying 10 days and longer • Directorate manager: Use of patient hotel has shortened length of stay and enabled reduction in pre-operative admissions • Clinical lead for Acute Medicine: Reviewing length of stay over 10 days and identify strategies for escalation within the organisation • Manager, Women's Division: Agreeing priority areas for improvement & focus on audit & service development for CQUIN • MSK Services Manager: Identified need to enhance the discharge process – will visit high performing hospital with 86% discharge within five days as opposed to our 73% Safety and quality outcomes • Clinical Director, Emergency Medicine: High discharge rate from Emergency Department achieved by good streaming of patients and GPs based in A&E sending patients home, so avoiding unnecessary hospital admission • Unit Manager AMU and Ambulatory Care: Reduce length of stay in Acute Medical Unit • Senior Nurse for Acute Medical Unit: Introducing weekly review of discharge summaries • Clinical lead for Acute Medicine; Focussing on patients with 0 -1 length of stay - consider ambulatory care potential for admitted patients. • Acute Medicine Consultants: Setting up of Fragility Units to improve care of elderly patients with multiple pathologies and avoiding unnecessary admission to hospital • Clinical Director: Introduction of patient contract has made mutual obligations more transparent and facilitated earlier discharge Civil Eyes Research also receives feedback about the value of the workshops from individual delegates. Civil Eyes Research elicit feedback about the value of shared practice within the workshops – 93% of workshop attenders rated this as very good or excellent. (B) Pathology networks (with Keele University) The selected action points have been grouped under the headings of efficiency, productivity, improved performance, and safety and quality outcomes. Efficiency • Clinical Director: Pathology information made available electronically within outpatients to improve patient flows • Laboratory Manager: Identified patient impacting diagnostic turnaround times linked to bed stays and used benchmarking information to raise these issues with the trust executive team • Laboratory Manager: Use of syndromic rules to influence and steer demand and embed protocols into use of Pathology services • Laboratory Manager: Included price of test in ordering system to raise awareness of resource implications and influence demand • Pathology Service Manager: Exploring length of stay: readmission relationship and impact on Pathology Productivity • Service Manager, Tissue Pathology & Molecular Service: Drill-down of skill mix including clinical validation of tests by grade / professional group • Director of Pathology: No Consultant programmed activities allocated for cut-up, instead performed more cost-effectively by junior doctors and other staff • Pathology Service Manager: Reviewed Pathology referral rates per 1,000 GP patients • Service Manager, Tissue Pathology & Molecular Service: Looked into day of admission versus length of stay, versus admitting specialty, and versus day of discharge Improved performance • Blood Sciences Manager: Looked into Emergency Department turnaround times and impact of timeliness of Pathology testing •Laboratory Manager: Implemented policy of reporting ward specimens by 0800 each morning to assist in expediting of discharge planning • Pathology Directorate Manager: Biochemistry activity / staffing - impact of running 2 x 24/7 services • Lead Biomedical Scientist: Impact of blood tests being performed before the patient attends outpatients for the first time – investigating one-stop shop approach and effect on waiting lists • Clinical Director: Streamlining of A&E / Pathology interface with low turnaround time for full blood counts, contributing to rapid A&E throughput Safety and quality outcomes • Microbiology Laboratory Manager: Investigate the use of more outcome measures (such as surgical site infections, mortality, infection rates and antibiotic usage costs) in relation to laboratory activity • Consultant Virologist/Clinical Director Labs: Review impact of helicobacter screening on endoscopy clinics and patient diagnosis / outcome • Cellular Pathology Manager: Took on the task of coming up with a cancer metric within Cellular Pathology that can be linked to HES data • Lab Manager Microbiology Department: Resolved to undertake a project to explore whether the relationship between GP requests lowers the number of patients arriving in hospital with infections • Clinical Director: Reintroduction of bench rounds appreciated by staff in terms of quality assurance and better supervision Civil Eyes Research also receives feedback about the value of the workshops from individual delegates and a very much shortened set of comments is shown below: • Lab Manager Microbiology Department: A very rewarding day’s activity, thank you • Directorate Manager, Laboratory Medicine: Certainly thought-provoking • Pathology Directorate Manager: Excellent and encourages interactive dialogue • Service Manager, Cellular Pathology: Good cross-discipline thought fertilisation • Blood Sciences Manager: Good to see how you compare to other laboratories and hospitals • Deputy Director of Pathology Services: Very thought-provoking Civil Eyes Research elicit feedback about the value of shared practice within the workshops – 91% of workshop attenders rated this as very good or excellent. (C) Specialist Children’s Hospitals Civil Eyes Research recently held two workshops at the request of the specialist children’s hospitals group, focusing on aspects of patients flows through hospital - admissions and ambulatory care, and length of stay and discharge. Benchmarked analysis of HES data was used to show A&E attendance patterns, hospital performance, the relationship of the specialist children’s hospitals to their networks, length of stay and readmissions. The analysis was used to prompt and stimulate sharing of good practice between the hospitals in the context of the facilitated workshops. The good practice areas were then widely disseminated across clinicians and managers of the specialist children’s hospitals. Examples of good practice included the following: • Development of an escalation policy covering the admissions process - makes Consultant involvement clear and has empowered junior doctors • Single point of admission to hospital • Consultant presence in ED until 2200 at a number of hospitals - a number of which have matched clinical resources in ED with activity by time of day • Hospitals are looking into introduction of seasonal job plans to better match resources with activity • Dedicated Consultant hotline for GPs • Implementation of models for paediatrician presence within the community • Use of long term care co-ordinators to reduce long hospital stays for children • A number of hospitals looking into better pathways for chronic / complex patients including avoidance of admission via ED • Development of dedicated ANP-led pathway for new-born babies with jaundice that has improved consistency of advice and avoided admission and unnecessary blood-taking; also providing advice on line care at home • A hospital operating a navigation hub to process referrals and improve the referral and triage processes, also run a daily rapid access clinic • Some hospitals using local hotels to avoid pre- and sometimes post-operative stays • Selected orthopaedics day cases admitted to and discharged home directly from theatre • Some hospitals using pharmacy pre-prepared packs to facilitate faster discharge • Development of regional discharge pathway for children with complex health needs including provision for escalation and repatriation to district general hospitals • Suggested co-location of discharge lounge with ambulatory care area • Paediatric Complex Care Discharge Co-ordinator role has improved liaison with Social Services and network hospitals and facilitated earlier discharge for complex patients • SAFER (Senior review, Anticipate, Flow, Early Discharge, React) programme at one hospital for patients staying over seven days with improved co-ordination and discharge planning • The development of nurse social worker roles, who operate within flexible, patient-focused criteria, has improved co-ordination of care for children with complex health needs and reduced long hospital stays Civil Eyes Research elicit feedback about the value of shared practice within the workshops – 95% of workshop attenders rated this as very good or excellent. Continued use of the HES data will enable Civil Eyes Research to continue to provide similar benefits to the healthcare organisations that opt to use its benchmarking and analytical services. The future benefits are expected to continue working with the same and additional organisations and will consist of identifying opportunities for improved use of NHS resources and potential improvements in the quality, patient-centeredness and timeliness of patient care. That NHS organisations have opted to use services from Civil Eyes Research over ten years shows that the services provided are valued by chief executives, medical directors and managers in helping with the management of healthcare and the improvement of efficiency, quality and timeliness in patient care. The outputs or analysis are ultimately delivered to improve patient care, pathways, healthcare services and value for money. The benefits provided are: • An improvement in patient care due to increased clinical productivity and the reduction in variability across the healthcare system in England. • Enhanced efficiency within clinical services improving capacity and access to services for patients. • Evaluation and benchmarking of NHS organisations helping to increase quality and outcomes for patients. • Providing insights and evidence to support providers in developing local services to provide the best care possible for their patients. • Better use and understanding of information within the NHS for all disciplines, specialties and hospitals with which Civil Eyes Research works.

Outputs:

The regular outputs are set out below for each of the three benchmarking clubs. These form the core work produced by the organisation. The outputs will be in the form of PowerPoint slides used at specialty and topic-specific workshops which are attended by senior doctors, nurses, other clinicians and managers from the hospitals involved. The Civil Eyes model is that data is used to prompt discussion about the clinical topic so that the hospitals can learn from each other in a facilitated meeting. The data in the slides will be in aggregate form with small numbers suppressed in line with the HES analysis guide. The encounters are workshops, not lectures, with typically between 20 – 30 attendees. The aim of the exercise is to use the data to explore and contrast the service arrangements and clinical practices that lie behind the information. The outputs will show NHS trusts the scope for better use of resources, for example how specialties could treat more patients if they achieved peer levels of productivity . The PowerPoint outputs will be produced and disseminated over the course of the 2016/17 year and issued to doctors, nurses, other clinicians and managers of healthcare organisations. Civil Eyes will also use the slides in local meetings with the hospital where the messages of the analysis and the workshop are shared with senior members of the hospital management team. (A) Medical productivity within NHS organisations During the last 12 months Civil Eyes Research has presented the PowerPoint slides to NHS organisations in 47 workshops. (B) Pathology networks (with Keele University) During the last 12 months Civil Eyes Research has presented the PowerPoint slides to NHS organisations in 37 workshops. (C) Specialist Children’s Hospitals During the last 12 months Civil Eyes Research has presented the PowerPoint slides to NHS organisations in 22 workshops. Civil Eyes Research issues to doctors, nurses, and managers of Specialist Children’s Hospitals an annual database in password-protected Excel file format of aggregated performance information covering length of stay, day case rates, same day operations, cancelled operations, depth of diagnosis coding and readmissions. The level of data is hospital, specialty and Healthcare Resource Group. Civil Eyes Research will not link HES data to other datasets. All outputs are in aggregate form with small numbers suppressed in line with the HES analysis guide.

Processing:

Civil Eyes Research will group the pseudonymised HES data to the latest Healthcare Resource Group (HRG) software and analyse the data at organisation, hospital, specialty, HRG, diagnosis and procedure level. The data are held on a prime database server dedicated to the sole use of Civil Eyes Research; the server is not connected to a network. The data will be stored and processed at the single address specified. The processing activities are the same for all three Benchmarking clubs. All individuals with access to the record level data are substantive employees of Civil Eyes Research.

Objectives:

The overall objective of Civil Eyes Research is to provide aggregated analysis and interpretation of performance and quality issues within healthcare to doctors, clinicians and managers of NHS and Social Care providers using benchmarking of HES data alongside the deployment of Civil Eyes Research’s own accumulated healthcare expertise over thirty years. Civil Eyes has been working with HES data over the past eleven years to support and improve the provision of patient care across the NHS throughout the UK. Civil Eyes Research has two principal directors who have long and significant track records within the healthcare sector where they have held a range of roles. They joined Civil Eyes Research in 2005 to provide services whereby doctors and managers could use data to understand service provision and effectiveness. Civil Eyes Research is commissioned by Chief Executives and Medical Directors of NHS trusts specifically to provide analysis and advice in order to promote discussion and action on efficiency, productivity, effectiveness, quality and access to services. Civil Eyes Research benchmarks HES activity with trusts to provide insights into their service profiles, performance and outcomes. Civil Eyes Research only works with health services in the UK and does not, and has no plans to, work in other sectors or outside the UK. Any such work would be subject to an application for an amendment to their agreement. Engagement with doctors and managers results in higher commitment to better coding, improved understanding of case mix and more robust use of information in the health service. HES data are held only in pseudonymised form and are never directly linked with other datasets which could allow re-identification of HES data. Reports are only issued to clinicians and managers of NHS organisations. No record level data is provided to any third party organisation in any format. Civil Eyes Research has not and will not use HES data to undertake sales and / or marketing activities to the healthcare or any other sector. Client engagements are either long-standing from Civil Eyes Research’s inception, as a result of their previous work within healthcare services, or have occurred by “word of mouth” recommendation. Civil Eyes Research has developed three Benchmarking Clubs or “purposes” where hospitals work together to review and understand the data and performance and plans to carry on with these three clubs using the 2015/16 HES data. The three clubs are: (A) Medical productivity within NHS organisations (B) Pathology networks (with Keele University) (C) Specialist Children’s Hospitals The use of data for these clubs is detailed below; (A) Medical productivity within NHS organisations Over the past eleven years, Civil Eyes Research has worked with 30 teaching hospitals and 25 district general hospitals (DGHs) scattered across the country and developed methodologies to analyse and present HES data to portray admitted care, outpatient and A&E activity by specialty across the full range of secondary care activity. The specialty list requested by hospitals includes: Acute and Emergency Medicine, Anaesthetics, Breast Surgery , Cardiology, Cardiothoracic Surgery, Care of the Elderly, Colorectal Surgery, Dermatology, ENT, Gastroenterology, Gynaecology, Haematology, Hepatobiliary Surgery, Intensive Care, Maternity, Nephrology, Neurology, Neurosurgery, Oncology, Operating Theatres, Ophthalmology, Oral & Maxillofacial Surgery, Plastic Surgery, Radiology, Respiratory Medicine, Rheumatology, Trauma & Orthopaedics, Upper GI Surgery, Urology and Vascular Surgery. Civil Eyes Research organises national workshops for service managers and lead clinicians at specialty or function level. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Service managers and lead clinicians are then invited to submit their recommended service changes to their local management teams. In addition Civil Eyes is asked to visit hospitals to share workshop analysis for in-depth review with local management teams. For instance, a hospital wishing to change practice will ask to see local comparisons, selected peers or best in class across England. Civil Eyes Research uses national data to: • Examine the mix of case types that are treated in specialist hospitals and non-specialist hospitals. When looking at the activity of a particular provider, it is necessary to understand the pattern of care at neighbouring hospitals as this will affect the volume, case mix and clinical characteristics (such as length of stay, day case rate or readmission rate) of the presenting healthcare activity at that provider. An example would be in the northeast where the large Ophthalmology service at Sunderland affects the Ophthalmology workload at South Tees and Newcastle. Another would be the presence of specialist Plastic Surgery at Queen Victoria hospital in East Grinstead which reduces the Plastic Surgery presence at the larger Brighton & Sussex trust. • Review shared care arrangements with specialist centres and local DGHs. An example would be looking at hub and spoke care models between teaching and district general hospitals, where, for example, cancer patients treated at a teaching hospital may re-present in any other hospital or specialty or mode (such as outpatients or A&E) at DGHs. This analysis helps clinicians and managers to understand and review the pattern of care given to patients and enables identification of improvements in efficiency and service quality. • Determine “best in class” performance across England. An example would be the operation rate on the day of admission for elective activity, where “best in class” has varied over time and specialty and provider. Using such benchmarks helps spur on clinical performance at other trusts and improves efficiency and importantly the quality of service for patients. • Review length of stay on a system-wide basis as opposed to that seen on a discrete provider basis (length of stay on a “super-spell” basis is looked at (for example, for elderly fractured femur patients) and look for Hospital A’s discharges re-appearing within other hospitals within a short time period – it has been found that discharged patients have subsequent admissions at a large number of other hospitals; clinicians and managers see this as a more acceptable way of looking at lengths of stay). • Provide peer groups to hospitals – clinicians and managers of particular hospitals may require comparator peer groups of any other hospital in England. This club comprises 25 trusts this year, 25 the year before and is expected to comprise 26 trusts in the following year. (B) Pathology networks (with Keele University) Starting January 2014, Civil Eyes Research has been working with Keele University Benchmarking Service to look across the UK at potential impact areas of Pathology work including the overall levels of Cellular Pathology, Clinical Biochemistry, Haematology, Immunology, Microbiology & Virology activity, patient pathways, infections, diabetes, anaemia, speed of patient turnaround in Accident & Emergency and proxies for one-stop arrangements in outpatients. Civil Eyes use the HES data to calculate national rates of activity across England and Keele University provides a national service to Pathology departments. The Keele University Benchmarking Service has been delivering the Pathology Laboratory Benchmarking programme to NHS organisations in the UK for over 20 years. It is the only organisation in the UK to collect and provide such information. The Keele University Benchmarking Service is peer reviewed and guided by specialty panels in each discipline, all of whom represent professional bodies including the Royal College of Pathologists and Institute for Biomedical Science. The recent Carter Review of Pathology services called for benchmarking and review of Pathology information. The Keele programme meets those objectives but the Review called for Pathology to be seen in the wider hospital context. Keele and Civil Eyes Research are working together to provide that wider perspective. Pathology networks can now see their performance in the wider hospital context through the use of HES data. Keele University Benchmarking Service has been historically strong at showing performance within Pathology laboratories, while Civil Eyes is using HES data to show potential impact areas of Pathology within the hospital and community context. Keele University Benchmarking Service collects contextual information (for example overall workload, staffing, test turnaround times and type of laboratory) from Pathology laboratories that Civil Eyes incorporates into analysis for the national workshops and local hospital meetings. Civil Eyes does not share record level data with colleagues in Keele. The HES data are solely managed by Civil Eyes, and Keele staff only see the same level of aggregated data as is present in the analyses received by client hospitals. Civil Eyes Research organises national workshops for service managers and lead clinicians. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Workshop participants are then invited to submit their recommended service changes to their local management teams. In addition, Civil Eyes is asked to visit hospitals to share workshop analysis for in-depth review with local management teams. Keele University is the only university with which Civil Eyes Research works. Keele University is the only third party with which Civil Eyes Research has a relationship for delivering services to clients. This club comprised 20 laboratories in 2015, 15 the year before and is expected to comprise 30 laboratories in 2016. The 30 laboratories cover 40 trusts as a number of laboratories provide services to a network of NHS trusts. Civil Eyes Research uses national data to: • Calculate national rates of activity (volumes of diagnoses and procedures, outpatients and A&E activities) across England for use within the benchmarking of Pathology services which, with Keele University, are provided to all Pathology departments. • Determine “best in class” performance across England. An example would be length of stay for a particular condition such as diabetes for non-elective activity, where “best in class” has varied over time and specialty and provider. Using such benchmarks helps spur on clinical performance at other trusts and improves efficiency and quality of service for patients. • Pathology services are organised on a network basis, quite often resembling counties, or combinations or counties, and do not map conterminously to NHS trusts. One laboratory may provide Pathology services to a number of NHS organisations including a number of quite small healthcare entities and the data for the small organisations is required to complete the picture of the services to which the Pathology activity relates. An example is an organisation called Empath which provides Pathology services to hospitals across Leicestershire and Nottinghamshire in the East Midlands including the independent treatment centre at Nottingham. (C) Specialist Children’s Hospitals Civil Eyes Research uses HES data to provide analysis of clinical performance and benchmarking information to a group of 20 specialist children’s hospitals scattered across the country covering areas such as lengths of stay, day case rates, readmissions, same day operations, depth of clinical coding and clinical performance within specialties. This group comprised 20 hospitals last year, 20 the year before and is expected to comprise the same number in the coming year as this is, by and large, a fixed sector within the NHS. Civil Eyes Research organises national workshops for service managers and lead clinicians at specialty or function level. At these events there is multi–disciplinary discussion using benchmarked activity data, best national practice and local experiences. Service managers and lead clinicians are then invited to submit their recommended service changes to their local management teams. In addition, Civil Eyes is asked to visit hospitals to share workshop analysis for in-depth review with local management teams. Civil Eyes Research uses national data to: • Examine patient pathways between national centres (e.g. Great Ormond Street Hospital) and other hospitals throughout England. An example would be enabling clinicians and managers to understand and review the splits of care between the thirteen specialist paediatric Nephrology centres across the UK and the other hospitals which they work alongside. • Review length of stay, patient activity and mode of treatment on a system-wide basis as opposed to that seen on a discrete provider basis. For example, patients with a chronic illness such as Crohn’s disease may attend their local hospital for clinical management and care but sometimes at “flare up” of their disease they will visit a specialist centre. Clinical networks are being established wherein patients attend, for example, Manchester Children’s hospital and also may visit their local hospital in Burnley or Morecambe Bay. NHS England is moving towards reimbursement of care for patients on a year-wide payment and care mechanism with the active support of the Royal Colleges. National data is necessary to see the entirety of patients’ encounters with health services.