Data from: Exploring emergency department 4-hour target performance and cancelled elective operations: a regression analysis of routinely collected and openly reported NHS trust data.

Objective: To quantify the effect of intra-hospital patient flow on Emergency Department (ED) performance targets and indicate if the expectations set by the NHS England five year forward review are realistic in returning emergency services to previous performance levels. Design: Linear regression analysis of routinely reported trust activity and performance data using a series of cross-sectional studies. Setting: NHS trusts in England submitting routine nationally reported measures to NHS England. Participants: 142 acute non-specialist trusts operating in England between 2012 and 2016. Main outcome measures: The primary outcome measures were: proportion of four-hour waiting time breaches and cancelled elective operations. Methods: Univariate and multivariate linear regression models were used to show relationships between the outcome measures, and various measures of trust activity including: empty day-beds, empty night-beds, day-to-night bed ratio, ED conversion ratio and delayed transfers of care. Results: Univariate regression results using the outcome of four-hour breaches showed clear relationships with: empty night-beds and ED conversion ratio between 2012-2016. The day-to-night bed ratio showed an increasing ability to explain variation in performance between 2015-2016. Delayed transfers of care showed little evidence of an association. Multivariate model results indicated that the ability of patient flow variables to explain four-hour target performance had reduced between 2012-2016 (19% to 12%), and had increased in explaining cancelled elective operations (7% to 17%). Conclusions: The flow of patients through trusts is shown to influence ED performance, however performance has become less explainable by intra-trust patient flow between 2012 and 2016. Some commonly stated explanatory factors such as delayed transfers of care showed limited evidence of being related. The results indicate some of the measures proposed by NHS England to reduce pressure on EDs may not have the desired impact on returning services to previous performance levels

An evidence-based approach to quality improvement for COVIDoximetry@Home

Robust data-driven insights are critical for the design, adaptation, and improvement of clinical and operational management policies governing care pathways and resource models. However, understanding the requirements for data and analysis can be challenging when faced with disruptive innovations that offer new or reconfigured services such as COVIDOximetry@Home(NHS England and NHS Improvement, 2020), and when such change impacts multiple providers in an Integrated Care System (ICS). In this report we outline measurement, monitoring and analysis of COVIDOximetry@Homeusing evidence-based practice as the underpinning foundation for PDSA quality improvement[1]. Many operational and clinical decisions should be considered, and it is the purpose of the data and analytics to offer decision makers with insights necessary to design, assessment and implement of policies for better care. ▪Clinical: predict patient outcomes; understand the efficacy of interventions at different COVID patient disease stages and associated clinical care settings▪Operational: understand how clinical services respond to workload and resources for planning, optimisation, and reconfiguration; identification and validation of processes▪Compliance: understand the degree to which services are operating according to procedures and practices▪Programme Evaluation: deliver evidence as part of programme evaluation and for sustainability investment decisionsWhilst the COVID-19 Virtual Wards Data Provision Notice (NHS Digital 2020-1) mandates the “data to be collected for the evaluation of the Virtual Wards pilot”, our work puts data into the context of digital systems, and ongoing clinical and operational quality improvement. We describe the COVID19 Virtual Ward concept and clinical setting, and then elaborate the clinical, operation, compliance, and evaluation requirements. Finally, we summarise a system view from an exemplar ICS, outlining the relation between structure and data

Exploring emergency department 4-hour target performance and cancelled elective operations: a regression analysis of routinely collected and openly reported NHS trust data

Objective: to quantify the effect of intrahospital patient flow on emergency department (ED) performance targets and indicate if the expectations set by the National Health Service (NHS) England 5-year forward review are realistic in returning emergency services to previous performance levels.Design: linear regression analysis of routinely reported trust activity and performance data using a series of cross-sectional studies.Setting: NHS trusts in England submitting routine nationally reported measures to NHS England.Participants: 142 acute non-specialist trusts operating in England between 2012 and 2016.Main outcome measures: the primary outcome measures were proportion of 4-hour waiting time breaches and cancelled elective operations.Methods: nivariate and multivariate linear regression models were used to show relationships between the outcome measures and various measures of trust activity including empty day beds, empty night beds, day bed to night bed ratio, ED conversion ratio and delayed transfers of care.Results: univariate regression results using the outcome of 4-hour breaches showed clear relationships with empty night beds and ED conversion ratio between 2012 and 2016. The day bed to night bed ratio showed an increasing ability to explain variation in performance between 2015 and 2016. Delayed transfers of care showed little evidence of an association. Multivariate model results indicated that the ability of patient flow variables to explain 4-hour target performance had reduced between 2012 and 2016 (19% to 12%), and had increased in explaining cancelled elective operations (7% to 17%).Conclusions: the flow of patients through trusts is shown to influence ED performance; however, performance has become less explainable by intratrust patient flow between 2012 and 2016. Some commonly stated explanatory factors such as delayed transfers of care showed limited evidence of being related. The results indicate some of the measures proposed by NHS England to reduce pressure on EDs may not have the desired impact on returning services to previous performance levels

Independent evaluation of the piloting of the implementation of MymHealth [myCOPD, myHeart and myDiabetes] by Dorset Clinical Commissioning Group

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NHS England routinely reported measures 2011-2016

NHS England routinely and openly publish reports of various measures which are collected across NHS services in England. The reports are made available here: https://www.england.nhs.uk/statistics/ . The statistics reported are grouped into &lsquo;statistical work areas&rsquo;, published separately, and are recorded over different time intervals (i.e. monthly, quarterly, yearly) which makes combined analysis time consuming. As part of a study into acute hospital pressure, various &lsquo;statistical work areas&rsquo; were combined into one file to complete analysis between calendar years 2011-2016. Contains public sector information licensed under the Open Government Licence v3.0.</span

NHS England acute trust performance (data + python code)

We have provided data in csv format ('variables_yr_acute.csv'). This is data at the yearly time period for the acute and teaching trusts investigated in the study. The full data set (for all trusts and at quarterly and yearly levels) is available at: https://eprints.soton.ac.uk/413163/ doi:10.5258/SOTON/D021

Head home: a prospective cohort study of a nurse-led paediatric head injury clinical decision tool at a district general hospital

Objectives: To assess if a nurse-led application of a paediatric head injury clinical decision tool would be safe compared with current practice. Methods: All paediatric (&lt;17 years) patients with head injuries presenting to Frimley Park Emergency Department (ED), England from 1 May to 31 October 2018 were prospectively screened by a nurse using a mandated electronic 'Head Injury Discharge At Triage' questionnaire (HIDATq). We determined which patients underwent CT of brain and whether there was a clinically important intracranial injury or re-presentation to the ED. The negative predictive value of the screening tool was assessed. We determined what proportion of patients could have been sent home from triage using this tool. Results: Of the 1739 patients screened, 61 had CTs performed due to head injury (six abnormal) with a CT rate of 3.5% and 2% re-presentations. Of the entire cohort, 1052 screened negative. 1 CT occurred in this group showing no abnormalities. Of those screened negative, 349 (33%)/1052 had 'no other injuries' and 543 (52%)/1052 had 'abrasions or lacerations'. HIDATq's negative predictive value for CT was 99.9% (95% CI 99.4% to 99.9%) and 100% (95% CI 99.0% to 100%) for intracranial injury. The positive predictive value of the tool was low. Five patients screened negative and re-presented within 72 hours but did not require CT imaging. Conclusion: A negative HIDATq appears safe in our ED. Potentially 20% (349/1739) of all patients with head injuries presenting to our department could be discharged by nurses at triage with adequate safety netting advice. This increases to 50% (543/1739), if patients with lacerations or abrasions were given advice and discharged at triage. A large multicentre study is required to validate the tool.</p

Cost-Effectiveness and Burden of Disease for Adjuvanted Quadrivalent Influenza Vaccines Compared to High-Dose Quadrivalent Influenza Vaccines in Elderly Patients in Spain.

Influenza is a contagious respiratory disease that causes severe illness and death, particularly in elderly populations. Two enhanced formulations of quadrivalent influenza vaccine (QIV) are available in Spain. Adjuvanted QIV (aQIV) is available for those aged 65+ and high-dose QIV (HD-QIV) for those aged 60+. In this study, we used a health economic model to assess the costs and outcomes associated with using aQIV or HD-QIV in subjects aged 65+. Using aQIV instead of HD-QIV to vaccinate an estimated 5,126,343 elderly people results in reductions of 5405 symptomatic cases, 760 primary care visits, 171 emergency room visits, 442 hospitalizations, and 26 deaths in Spain each year. Life-years (LYs) and quality-adjusted LYs (QALYs) increases by 260 and 206, respectively, each year. Savings from a direct medical payer perspective are EUR 63.6 million, driven by the lower aQIV vaccine price and a minor advantage in effectiveness. From a societal perspective, savings increase to EUR 64.2 million. Results are supported by scenario and sensitivity analyses. When vaccine prices are assumed equal, aQIV remains dominant compared to HD-QIV. Potential savings are estimated at over EUR 61 million in vaccine costs alone. Therefore, aQIV provides a highly cost-effective alternative to HD-QIV for people aged 65+ in Spain