User Guide Hospital Spells Analysis Dashboard v1.0 (May 18) Page 1

User Guide: - Hospital Spells Analysis Dashboard

May 2018

1. Introduction

Variation in length of stay is a key area of interest for Health Boards. Within Discovery this information was

originally only available at episodic and specialty spell level.

This document provides guidance for the ‘Hospital Spells Analysis’ suite of workbooks contained within the

dashboard. The dashboard has been developed as part of the Discovery Sprint process which commissioned

the development of a suite of workbooks that provide information on hospital spells. A summary of the

reasons for developing this dashboard is provided below and the specific workbooks that have been developed

are also described. Guidance on how the dashboard can be used is provided and a number of scenarios are

presented to help show how they could be used to help investigate variation and monitor trends over time.

It is hoped that this guidance will assists NSS Discovery users in navigating and maximising the usability of the

information provided within the Hospital Spells Analysis dashboard suite. The aim of the dashboard is to

provide Discovery users with the ability to analyse and compare variation in Hospital Length of Stay (HLOS) for

discharging conditions and main operations while removing the vagaries of different patient journeys

influenced by variations in service provision and patient management.

2. Locating the Hospital Spells Analysis Dashboard

Log in with your Discovery username & password (click here for more information regarding requesting access)

and navigate to the Hospital Spells Analysis Dashboard.

a) You can get to the Hospital Spells Analysis Dashboard directly using this link. b) You can access it via the Discovery ‘A-Z’ menu (accessible via the orange head icon located at the

top right of most visualisation in Discovery). c) You can also quickly access it if you have previously saved it as a favourite by clicking on the star

icon in the Discovery Toolbar (see our Bespoke Views and Navigation Guide).

3. Rationale for developing a Dashboard that provide analysis by hospital spells LOS

A patient can have multiple episodes or specialty spells within a single hospital stay A change from General Medicine to Respiratory Medicine would create a new specialty spell however it is

still the same patient journey and may relate to the same condition.

For the original Discovery average length of stay indicators, (episodes and specialty spells) zero day stays are excluded.

Small proportions of patients with long lengths of stay can skew the average length of stay figures that is currently presented. Within Discovery, length of stay distribution information was not originally available.

4. Methodology

Hospital Spells have been calculated as an unbroken period of time that a patient spends within a hospital. A

patient may change specialty, consultant or significant facility during a hospital spell. A change in hospital

location would create a new hospital spell.

User Guide Hospital Spells Analysis Dashboard v1.0 (May 18) Page 2

Example patient journey

The example below shows a patient pathway and outlines how this is counted in terms of episodes, specialty

spells and hospital spells.

A patient with one continuous inpatient stay (CIS) made up of 6 episodes moved from A1 General Medicine to

AQ Respiratory Medicine and then to C3 Anaesthetics (high dependency unit) and then back to AQ Respiratory

Medicine, and was then transferred to a community hospital under specialty E1 General Practice.

Episode

Start Date

Episode

End Date

Episodic

LOS

Consultant Specialty Significant

Facility

Hospital Main

Diagnosis

Main

Procedure

27/03/18 29/03/18 2 D A1 40 A J44 Null

29/04/18 31/04/18 2 F AQ 11 A J44 Null

31/03/18 03/04/18 3 A AQ 11 A J44 E85

03/04/18 05/04/18 2 C C3 1H (HDU) A J44 Null

05/04/18 12/04/18 7 A AQ 11 A J44 Null

12/04/18 29/04/18 17 E E1 11 B J44 Null

Summary calculations of the example:

Hospital Spells Analysis Dashboards

Discovery Indicator ‘Average LOS-Episodic’

Discovery indicator ‘Average LOS- Specialty spells’

2 Hospital Spells

1 for Hospital A LOS of 16 Days (Discharging specialty AQ, Discharge Diagnosis J44, Main Procedure Of Spell E85, Admitting Sig Fac. 40, Discharging Sig Fac. 11, Discharging Consultant A)

1 For Hospital B LOS of 17 days.

For Diagnosis J44=33 days / 6 episodes = 5.5 days Ave. LOS

For Specialty AQ = 12 days / 3 episodes = 4 day Ave. LOS

For Specialty A1 = 2 days/1 episode = 2 Day Ave. LOS

For Specialty C3 = 2 days/1 episode = 2 Day Ave. LOS

For Specialty E1 = 17 days/1 episode = 17 Day Ave. LOS

For Diagnosis J44 = 33 days / 5 specialty spells = 12.1 day Ave. LOS

For Specialty AQ = 12 days / 2 specialty Spells = 6 day Ave. LOS

For Specialty A1 = 2 days/1 episode = 2 Day Ave. LOS

For Specialty C3 = 2 days/1 episode = 2 Day Ave. LOS

For Specialty E1 = 17 days/1 episode = 17 Day Ave. LOS

As can be seen from the above examples dependent on the methodology/indicator used (and the patient’s

journey through the system) you can get different results, for what is ultimately 1 patient admission for

Chronic Obstructive Pulmonary Disease {COPD} (J44). The Hospital Spells Dashboard attempts to allow

transparent analysis and comparison for conditions and procedures within hospitals.

As part of the Discovery Sprint process Health Boards requested analysis by hospital spells as oppose to

Continuous Inpatient Stays as hospital spells provides a hospital team with access to information around

processes they control.

5. Benefits of Hospital Spell Analysis dashboard developments

Some benefits of developing these Dashboards and providing analysis by Hospital Spell Information within

Discovery are as follows:

User Guide Hospital Spells Analysis Dashboard v1.0 (May 18) Page 3

Benefit Description Greater Transparency

Removes the vagaries of different patient journeys influenced by variations in service provision and patient management. Greater range of filters to allow users to drill down to a more detailed level as required.

Improved Trend Analysis

Denominator is hospital admissions as opposed to specialty spells or episodes, which is clearer and more understandable. Provides clearer trend information for specific conditions and operations.

Hospital Focus

The focus on hospital spell information provides users with access to information around processes they can control.

Hospital Length of Stay (HLOS) Profiles

Provides functionality that allows users to identify differences among length of stay profiles for Hospitals, Specialties, Conditions, Operations and Consultant teams.

- Users will be able to include/exclude zero day lengths of stay and patients with long lengths of stay, which may skew the average.

Acute Assessment Units (AAU) (Significant Facility 40)

A number of hospital sites have established these units. AAU often assesses patients sent to the hospital by GP practices. Other hospital sites may not have a separate assessment area and these patients may initially be managed completely within an Emergency Department (ED) prior to discharge home. This variation in service provision across different sites can impact on the data. Functionality is provided to allow users to include/exclude activity admitted to or discharged from an Acute Assessment Unit (Significant Facility 40).

Diagnostic, Procedure, Specialty and Consultant Analysis

Diagnosis-based information relates to the main diagnosis from the discharging episode of the hospital spell. All bed days for the hospital spell are linked to this diagnosis. Procedure-based information relates to the first main procedure that takes place within the hospital spell. All bed days for the hospital spell will be linked to this procedure. Users can group specific diagnoses or procedures together and compare average hospital lengths of stay for these specific conditions/procedures across hospitals and Scotland.

Other Information:-

Admission Type - From first/admitting episode (within hospital spell)

o Elective = Admission Type 10, 11, 12 or 19

o Planned Transfer = Admission Type 18

o Non-Elective = All other Admission Types

Consultant – From last/discharging episode (within hospital spell)

Age Group – Age on Admission From first/admitting episode (within hospital spell)

Dates – Dates of Discharge – From last/discharging episode (within hospital spell)

Discharge Destination – From last/discharging episode (within hospital spell)

o Helps identify hospital to hospital transfers.

Discharge Diagnosis – From last/discharging episode (within hospital spell)

Discharge Specialty – From last/discharging episode (within hospital spell)

Procedure – From 1st recorded main procedure in the hospital spell. (i.e. if the first recorded procedure is on

the 2nd episode of the hospital spell then this is the procedure that is shown for the full hospital spell)

Significant Facility – A significant facility is a type of clinical facility which is identified for clinical and/or costing

purposes. Within this dashboard the significant facility recorded for both the admitting episode and the

Discharging Episode are available. For example a significant facility code of 40 is an ‘Acute Medical Unit (AMU)’

User Guide Hospital Spells Analysis Dashboard v1.0 (May 18) Page 4

Specialty Spell Bed Days Information

Please note that within this Hospital Spell Analysis dashboard there is a workbook that shows bed days used by

specialty spell. This is the number of bed days based on any specialty that these patients have moved through

during their hospital spell. Functionality allows the user to filter for the hospital discharge diagnosis or the 1st main

procedure/operation the patient underwent during their hospital spell or the patient’s hospital discharging

specialty and the user will see the overall bed days used by individual specialties that these patients passed

through during their hospital spell.

Hospital Spells Analysis Dashboard Suite Functionality Quick Summary

This Dashboard provides functionality that allows users to identify differences among length of stay

profiles for hospitals, specialties, conditions, operations and consultant teams.

Users can include/exclude zero day lengths of stay and patients with long lengths of stay, which may skew

the averages shown.

Proportion of activity for all diagnosis/conditions and procedure/operations is available by hospital spell

discharging specialties.

It is hoped that the approaches described above and the functionality included in this development will allow clearer and easier analysis of length of stay information.

6. Hospital Spells Analysis Dashboard Guidance

A user must choose a Health Board of Treatment when they access this suite of workbooks. Workbooks in this area are controlled by the filters at the top of the screen. Changing a common filter on any of the workbook tabs will impact on all of the workbooks in this area.

Hospital Spell Landing Page Summary information on what is included in this dashboard.

1. User must choose a Health Board for the visualisations within these workbooks to load.

2. Information on hospital spells methodology and developmental reasons.

3. Example scenarios for workbooks are provided by hovering over the ‘i’

4. Clicking on the arrow will take the user to that workbook

5. Links to further information including metadata are available by hovering over the orange head Icon.

User Guide Hospital Spells Analysis Dashboard v1.0 (May 18) Page 5

Health Board The Health Board tab workbook shows benchmarked trend comparisons for your HB with Scotland for:- 1. Mean average

hospital length of stay

2. Length of stay distribution

3. Year on Year % Change (compared to same month previous year)

4. Functionality that allows activity to be switched between hospital spells and Bed Days

5. Health Board Bed Day and Hospital Spell Trend is also provided

6. Median + 75th Percentile hospital LOS

Users have a number of filters that provide the functionality to drill further into this information: o Discharging

Specialty o Discharging

Diagnosis o 1st Main

Procedure (of Hospital Spell)

o Discharging Destination

o Admission Type o IPDC o Age Group o Hospital LOS

Group o Admitting and

Discharging Significant Facilities

Scenarios this workbook could be useful for:-

Has a change in service provision for a specific cohort of patients led to a reduction in short stay admissions?

o User selects cohort of interest (e.g. a discharging diagnosis or age group). Can now assess change in trends, average length of stay and bed days to see if this change is having the desired effect. User can drill down to specific LOS Groups

Is there an increase in AMU Activity? o User can select Admission Significant Facility “Acute Medical Unit (AMU)” to

assess activity that goes through the AAU area o User can select “Acute Medical Unit (AMU)” as admitting and discharging

significant facility to asses if this area is discharging more patients home.

How many patients are being discharged on the day of admission? Is this changing over time?

o User selects Spell LOS Group of 0. Workbooks refine for this selection. o How is this comparing to Scotland?

These types of analysis were not originally available in Discovery. This visualisation allows focused trends to be analysed and service changes monitored. The functionality and visualisations available in this workbook allows the user to more fully investigate services changes for specific patient groups and monitor any changes over time.

User Guide Hospital Spells Analysis Dashboard v1.0 (May 18) Page 6

HOSPITAL Similar workbook to the “Health Board”, but information is provided at a hospital level. Provides information for each hospital location within the Health Board with comparisons to a peer group and Scotland. 1. Location Filter

allows user to focus on specific Hospitals

2. Hospital activity trend analysis for Bed Days and Spells

3. Year on Year % Change (compared to same month previous year) by individual hospital ability to switch between hospital spells and bed days.

4. Length of Stay distribution profile shows the proportion of total patients discharged by their LOS in Hospital and the cumulative proportion of patients discharged, i.e. by day 3, 45% of all patients have been discharged.

Scenarios this workbook could be useful for:

Are Elective Inpatients with the same operation being discharged earlier in other locations?

o User can select Elective IP (5) for a specific procedure (6) and this visualisation will show if different hospitals are discharging patients earlier than elsewhere.

Are Non Elective Patients with the same condition being discharged earlier in other locations?

o Users can select Non Elective admissions from the Admission Type filter (5) and specific conditions from the Discharge Diagnosis filter (7). Being able to drill down to individual conditions and group them together provides potentially useful functionality to investigate variations. User can also choose a specific discharging specialty or leave it as all specialties.

Are patients with a long length of stay skewing the overall average? o User can filter the information by LOS Group (9) and identify or exclude patients

with longer hospital lengths of stay to assess the impact of this patient group. Users can identify/exclude transfers between hospitals based on either Admission Type

(‘planned transfer’) (5) or Discharge Destination (8) (‘Transfer Same Provider’). This may allow users to identify/exclude patients that may be transferred to a specific site for a specific procedure before being transferred back to their home hospital. This functionality could allow a more like for like comparison for hospitals. The Diagnosis and Procedure workbooks allow users to identify what these patients have been transferred for.

User Guide Hospital Spells Analysis Dashboard v1.0 (May 18) Page 7

Diagnosis/Consultant This workbook provides information on the number and proportion of bed days, hospital spells and average length of stay by:

Discharge Diagnosis

Consultant At a HB or hospital

level Similar filters as previously discussed. 1. GMC filter allows

users to build consultant teams.

2. Top 20 Discharge Diagnosis for user selections made on filters. Shows proportion of hospital spells or Bed Days (8) shown.

3. All Discharge Diagnosis for filter selections made.

4. Hospital Activity Trend (Spells or Bed Days) (8).

5. Scatter plot compares average hospital LOS for the discharging consultant. An Activity Slider bar allows consultants with low activity to be excluded from this scatter chart.

6. Summary activity table split by hospital.

7. Summary activity table split by Discharge Diagnosis and Consultant.

8. User Switch, to switch activity shown by hospital spells or bed days.

Scenarios this workbook could be useful for:

What are the high volume diagnosis for my Discharging Specialties o Hospital Spell and Bed day information available o Note: tool tip provides average hospital length of stay information o Note: based on Specialty/diagnosis of discharge

How does this compare to other hospitals? o Hospital (Location) filter exists and table at top right of dashboard

What is the volume of activity for a specific consultant team/individual consultant o GMC code filter exists to allow consultant teams to be selected and analysed. o Individual views can be saved

How is the activity for a specific consultant team changing over time? o Trend Chart (4) will update to show trend for the consultant team selections

made How does the Hospital Ave LOS vary between consultants for specific conditions?

o Consultant Scatter plot (5) and table (6)

User Guide Hospital Spells Analysis Dashboard v1.0 (May 18) Page 8

Procedure/Consultant This workbook is similar to the Diagnosis/Consultant workbook. This workbook visualisations are focussed on the:- 1. 1st main procedure

of the hospital spell.

2. There are a number of hospital spells where patients do not have a procedure.

3. User can filter out ‘No Procedures during hospital spell’ via the 1st Procedure Hospital Spell filter as required. Please note this will exclude this activity from all workbooks in this area.

User Guide Hospital Spells Analysis Dashboard v1.0 (May 18) Page 9

Specialty Spell Bed Days This workbook shows the bed days used by specialty spell, by discharging diagnosis 2 and 1st Main Procedure of the Hospital Spell 3. 1. This is the number

of bed days based on any specialty that these patients have moved through during their hospital spell.

2. This bar chart shows the number of bed days that a patient has spent in each individual specialty for the hospital spell discharge diagnoses.

3. This Bar Chart visualisation is focussed on the 1st main procedure of the hospital spell.

Scenarios this workbook could be useful for:

In which specialties are patients who had a Stroke, for example, being treated? o If a user filters by a specific discharge condition this workbook will update to show

which specialty these patients have spent time in, (5).

Which specialties are patients being transferred through before hospital Discharge? o If a user filters for a specific discharging specialty (4). Bar Chart 2 refines to show

the conditions patients are discharged with from this specialty and also the number of bed days spent in other specialties before they are discharged by this specialty

o Bar Chart 3 will refine to show the 1st main procedures that the patients discharged from this specialty had during this hospital spell.

Is a patient getting care in the most appropriate specialty? o This workbook can show the proportion of time patients discharged from one

specialty (e.g. Geriatric Medicine) are spending in other specialties.

What are patient’s final hospital diagnoses for a specific procedure? o If a user filters by a specific 1st Main Procedure (6) this workbook will update

to show what the final hospital discharge diagnosis was, and which specialty these patients have spent time in during this hospital spell.

Note specialty is derived from the patient’s consultant and, as such, this workbook will not identify boarders.

5. Feedback and Queries

Further Developments to the Hospital Spell Analysis dashboards are planned including:-

o A Hospital Peer Analysis workbook where individual hospitals can benchmark their activity against their

amalgamated hospital peer group

o Benchmarked analysis by Local Authority of Residence

Please contact the Discovery Team to discuss any feedback, queries and also any developments/changes you

feel would be useful.

http://www.nssdiscovery.scot.nhs.uk/