Urgent Care Data Mart (UCD) Background Paper

Transcription

1 Urgent Care Data art (UCD) Background Paper ection 1 ummary of UCD What is the UCD Data art The Urgent Care Data art (UCD) is a collaboration between PHI ID (Public Health Information, Information ervices Division), NH 24 and cottish Ambulance ervice (A). The data mart links data from (NH 24, cottish Ambulance ervice, Out of Hours Primary Care (PC OOH), Emergency Department, Acute, ental Health and Deaths) to show a patient journey for records with a valid CHI number. This data will help understand the full patient journey through emergency and urgent care services e.g. from first contact by telephone with NH 24, transport by ambulance to an A&E department and then emergency hospital admission. What Data is Contained in the UCD NH 24 This data comes from telephone contacts with NH 24 and covers all clinical and dental calls, excluding calls to NH Inform. Historical Data is available going back to 1 st January cottish Ambulance ervice (A) This data covers incidents where a crew have attended (arrived on scene). It excludes air ambulance records and records from crews which were cleared from an incident with a reason of dealt with by another vehicle. Historical Data is available going back to 1 st January Primary Care Out of Hours Data This data comes from contacts with Primary Care Out of Hours services - services for patients when their registered GP Practice is closed and they are too ill to wait for them to reopen. Out of hours is 6pm to 8 am, onday to Friday and all day aturday and unday. Historical Data is available going back to 1 st April A&E Data The A&E data within UCD contains data on episode level new and unscheduled attendances at Emergency Departments and some smaller community hospitals and minor injury units (IUs). It does not include aggregate returns that are currently included in the A&E data art. Data is available from 1 st January 2011 to the present time.

2 R01 (Inpatient Activity) The acute inpatient activity data in the UCD Data art has been taken from the ACaDe data mart which contains acute activity data from the R01 data set. The acute activity data in UCD has been restricted to emergency admissions. Data is available for stays in hospital starting from 1 st January 2011 to present time. R04 Psychiatric Inpatient Activity Psychiatric inpatient activity data in the UCD Data art has been taken from the ACaDe data mart which contains acute inpatient psychiatry activity data from the R04 data set. The acute activity data in UCD has been restricted to non-respite admissions. Data is available for stays in hospital starting from 1 st January 2011 to present time. Deaths Deaths information from 1974 onwards has been included in the data mart. This information does not form part of a pathway, but is included to allow for derivation of time from a specific unscheduled care event till death. easuring Patient Journeys: Continuous Urgent Care Pathways (CUPs) A Continuous Urgent Care Pathway (CUP) is an unbroken time that a person spends in a series of emergency/urgent care services which occur within 24 hours of each other. (If the gap being measured is between any other event and an acute or mental health stay, the gap is within 48 hours). If a person contacts NH 24 and attends an A&E department after two days this would be treated as two separate CUPs. The UCD currently collects a start and end time for most emergency/urgent care service contacts. Currently it is not possible to put an end and start time on hospital admissions. The UCD assigns a time stamp of 23:59 on both dates of admission and date discharge/transfer to allow time differences to be calculated and included in pathways. Each emergency and urgent care service is assigned a code letter: N=NH 24, =cottish Ambulance ervice, E=Emergency Department, A= Acute hospital emergency stay, =mental health non-respite stay, O = Primary Care Out of Hours. There are a number of different pathways based on a combination of the above. Linking together the codes in chronological order describes the pathway name e.g., the pathway name NE would be a call to NH 24, followed by an Ambulance ervice contact and an Emergency Department attendance all within 24 hours of each other.

3 Patient Details Information The UCD contains nationally held data on patients. This uses the Community Health Index Number, or CHI and links directly to IDs patient data files rather than using any patient details submitted as part of the service contacts. Demographic Data The UCD includes the following demographic information that can be used to get a further breakdown of the information available in the data mart: Age Gender Deprivation (cottish Index of ultiple Deprivation) Geography (e.g. NH Board, Local Authority, Urban/Rural, Hospital, GP Practice) Diagnosis, presenting complaints and symptoms The UCD holds clinical information for each of the different data sources. For A&E there are four different variables that look at reasons why people are attending A&E: presenting complaint (free text), disease code (ICD10 codes), diagnostic grouping (list of grouped condition) and Diagnosis grouping (structured text that varies across Health Boards). NH Boards vary across cotland on how they record the data and which fields they complete. The Primary Care OOH National dataset currently contains READ codes. When a clinician assesses a patient in the Out of Hours (OOH) setting they select one (or more) Read codes. The A have a structured data field for presenting complaint and another separate coded structure for Diagnosis. NH 24 have a structured text field for ymptoms. For acute hospital admissions ICD10 codes are available for those patients who have been discharged. There is the main ICD10 code as well as up to six secondary codes. ICD10 codes for deaths data does not form part of the pathways but is included for analysis for primary cause and positions zero to 9. ection 2: Data Items included in UCD Link to A&E Data in UCD Emergency/ LINK TO R01/04 Cribsheets

4 Link to Primary Care Out of Hours Data contained in UCD A Data in UCD Datamart Data Item Description Field Format Priority Notes Call tarted Date Time The Date Time the call was taken by the EDC. DateTime Incident No A number to uniquely identify the incident within the Varchar(15) EDC. EDC The call centre based upon the incident location and not the centre that took the call. Varchar(30) Paisley Control Area is to be mapped to Cardonald Control Area. N/A will be nulled. Patient No A number to uniquely identify a patient at resource incident Varchar(3) level. If multiple resources are allocated to one incident the same patient could be seen by more than one resource but may be allocated different patient numbers. Callsign A number to uniquely identify a resource, e.g. ED456. Varchar(10) All callsigns were changed in April 2011 which may impact on callsign counts. Resource Allocated The Date Time a resource was allocated to attend an DateTime Date Time incident. Resource obilised Date Time Resource Arrived cene Date Time Resource Left cene Date Time Resource Arrived Destination Date Time Resource Cleared Date Time The Date Time a resource was mobilized to attend an incident. DateTime The Date Time a resource arrived at the scene of an DateTime incident. The Date Time a resource left the scene of an incident. DateTime The Date Time a resource arrived at its destination, e.g. DateTime hospital, care home. The Date Time a resource was cleared to be available to DateTime attend another incident. Patient Forename The forename of the patient. Varchar(20) Patient urname The surname of the patient. Varchar(50)

5 Patient CHI Number The patient s CHI number. Varchar(10) Gender The gender of the patient, i.e. ale, Female. Varchar(10) DOB The patient s date of birth. Date Patient Age The patient s age. Int Patient Postcode The patient s postcode at the time of the incident. Varchar(10) ethod of Call The method of call, e.g. Police, Fire ervice, Coastguard, NH24 etc. Varchar(255) Hosptial will be corrected to Hospital during the file processing. Unknown and N/A will be nulled. Call Type The type of call, i.e. Emergency, Urgent or Routine. Varchar(10) Call Category The emergency call category, e.g. Cat A Call. N/A will be Varchar(15) submitted for urgent and routine calls, i.e. non-emergency calls. Resource Type Type of vehicle of a callsign, e.g. Accident and Emergency. Varchar(40) The asterisk submitted at the end of the file name will be removed during processing. Journey Type The type of journey undertaken by a resource, e.g. Varchar(40) Admission, Inter-Hospital Transfer. Call topped Reason The reason the call was stopped recorded by the EDC, Varchar(40) e.g. Not required good intent. Clear Reason Desc The reason the call was stopped recorded by the crew, e.g. Varchar(40) Dealt with by other vehicle. Full Postcode The postcode of the location of the Incident. Varchar(8) Incident Easting The easting of the location of the incident. Int Incident Northing The northing of the location of the incident. Int ub Division The geographical sub division areas, e.g. Argyll and Clyde, Varchar(50) Fife. N/A will be nulled. To Hospital Allocated Hospital - the name of the hospital the patient Varchar(2000) was allocated to be taken to by the EDC based upon the geography of the incident. The list of hospitals is not stable so a reference file cannot be provided. Receiving Hospital The name of the hospital the patient was taken to for Varchar(200)

6 treatment entered by the crew. The list of hospitals is not stable so a reference file cannot be provided. Despatch Code Presenting Complaint - the initial diagnosis code recorded Varchar(15) by the EDC, e.g. 33C02. Chief Complaint Group Presenting Complaint Group the grouping of the initial Varchar(2) diagnosis code. Final APD Code Diagnosis - the diagnosis code recorded by the paramedic Varchar(6) after treating the patient. Alcohol Indicates if the call was associated with alcohol abuse. DateTime Opiate Indicates if the call was associated with opiate abuse. DateTime Amphetamine Indicates if the call was associated with amphetamine DateTime abuse. Barbiturate Indicates if the call was associated with barbiturate abuse. DateTime Inhalant Indicates if the call was associated with inhalant abuse. DateTime Cannabis Indicates if the call was associated with cannabis abuse. DateTime Cocaine Indicates if the call was associated with cocaine abuse. DateTime Ecstasy Indicates if the call was associated with ecstasy abuse. DateTime Other ubstance A freetext field to describe the other substance the call may Varchar(2000) Description have been associated with. Circulation Treatment Indicates if an IV Cannula was used as a Circulation DateTime IV Cannula Treatment. Circulation Treatment Indicates if IV Fluids was used as a Circulation Treatment. DateTime IV Fluids Pulse Rate The patient s pulse rate. Int Respiratory Rate The patient s respiratory rate. Int BP ystolic The patient s ystolic blood pressure. Int PO2 The measure of the patient s oxygen saturation. Int Temperature The patient s temperature. Varchar(5) AVPU The patient s AVPU score, i.e. Alert, Voice, Pain, Varchar(20) Unresponsive. EW The patient s cottish Early Warning ystem score (from 0 Int to 18). GC Eye Opening The patient s eye opening rating on the Glasgow Coma Varchar(20)

7 cale, e.g. spontaneous. GC Verbal Response The patient s verbal response rating on the Glasgow Coma Varchar(20) cale, e.g. incomprehensible. GC otor Response The patient s motor response rating on the Glasgow Coma Varchar(20) cale, e.g. Extension to Pain. GC Total The patient s Glasgow Coma cale score (a number Int between 3 and 15). ECG Choice A freetext field indicating the ECG Choice, e.g. NR. Varchar(2000) Crew ember 1 Indicates if the first crew member was a paramedic. Varchar(1) Paramedic status Crew ember 2 Indicates if the second crew member was a paramedic. Varchar(1) Paramedic status Doctor In Attendance Indicates if there was a doctor at the scene. DateTime Police In Attendance Indicates if there were police at the scene. DateTime NH24 Data in UCD Datamart Data Item Description Field Format Notes Priority Call ID A unique call reference number assigned by Number (8) NH 24. Call Received Date The date time the call was received by NH Date Time Format Time 24. DD//YYYY.hh:mm:ss Disposition ID Outcome of Call (NH 24 IH) Varchar (3) A code to identify the outcome of the call, i.e. where the patient was advised to go to/contact. A one-off reference file will be provided to populate the reference table, which will include the code, description and grouping. Outcome Code Outcome of Call (NH 24 OOH) Varchar (5) A code describing the action NH 24 has recommended if the call was made out of hours (including Public Holidays and Protected Learning Time).

8 A one-off reference file will be provided to populate the reference table, which will include the code, description and grouping. Null will be defaulted to No Outcome Code. CHI Number Patient's CHI number. Varchar (10) The CHI number will be zero padded. Family Name Patient s surname. Varchar (20) Given Name Patient s forename. Varchar (20) DOB Patient s birth date. Date Time Format DD//YYYY.hh:mm:ss The time component will be removed during file processing. Gender Patient s current gender (ale, Female, Varchar (10) Unknown). Postcode The location of the patient at the time of the Varchar (10) call, which may not be their home postcode. Protocol Title Diagnosis Varchar (100) The final algorithm title, which is a free text field detailing the indicator of patient s present symptoms. Call Reason Free text field describing the initial reason Varchar (100) for the call. Date/Time call The Date/Time the call was closed. Date Time Completed Format Note: the data item was referred to as the DD//YYYY.hh:mm:ss first time the call was completed because it is possible that the patient may call again and their original Call ID will be reopened. Only a single record will be submitted for each Call ID. Call Type The type of call. Only Clinical and Dental calls Varchar (20) will be included. Call Origin Where the call has originated from e.g. A Varchar (20) (Cat 'C'), Other A reference list will be provided. Null will be defaulted to General NH 24

9 Call ervice Provider Health Board of Treatment (NH 24 OOH) Varchar (20) The Health Board area which dealt with the call during the Out of Hours period (including Public Holidays and PLT). A reference file will be provided containing the character field and description. Data transfer consent Where the patient has given consent for Varchar (10) their data to be transferred to GP systems Yes/No/Partial Partner Area Code Health Board of Treatment (NH 24 IH) Varchar (2) The code of the Health Board area which dealt with the call. Note: the Partner Area Code field is selected by the member of staff who received the call and is dependent on the individual s geographic knowledge. Validation carried out on the Partner Area Code over all records in 2010 shows a 98% accuracy level. A reference file will be provided containing the character field and description. ection 3 Chronic Conditions, ignificant Factors, and cottish Patients at Risk of Readmission and Admission (PARRA) core in UCD Chronic Conditions The UCD contains Flags to indicate if a patient has suffered from a long term condition for all records with a valid CHI number. These flags can be applied to NH24 Calls, Primary Care Out of Hours services, A incidents, ED attendances and acute admissions as they are included in the common class in the Business Objects universe.

10 All acute records with a Date of Admission on or after the 01 April 1981 will be used to identify patients who have experienced a long term condition. The flags are available for the following long term conditions. Arthritis Asthma Atrial Fibrillation Cancer Cerebrovascular Disease Chronic Liver Disease COPD Dementia Diabetes Epilepsy Heart Disease Heart Failure ultiple clerosis Parkinsons Disease Renal Failure The flag is based on records containing a disease code in any of the diagnosis positions for a particular long term condition. ignificant Factors The UCD also contains flags for ignificant factors involved in a patient pathway and contact with emergency and urgent care services. For NH 24 there is ubstance elf-harm Related isuse Related Burns/calds Related Falls Related For A/ED Alcohol Related ubstance isuse Related elf-harm Related Burns Burns/calds Related Road Traffic Accident Related Falls Related

11 Assault Related Police Involved For Acute Admissions Alcohol Related ubstance isuse Related elf-harm Related Burns Burns/calds Related Road Traffic Accident Related Falls Related Assault Related Police Involved cottish Patients at Risk of Readmission and Admission (PARRA) core cottish Patients at Risk of Readmission and Admission is a risk prediction tool developed by ID which predicts an individual's risk of being admitted to hospital as an emergency inpatient within the next year. cores are calculated for approximately 4.2 million patients. PARRA scores can range from 1 to 99% for patients in the cohort. Patients with a score of 50%, for example, are generally said to have a 1 in 2 chance of being admitted to hospital in the prediction year. The UCD contains PARRA scores where there is a valid CHI. imilar to Long Term Conditions a PARRA score can be applied to NH 24 Calls, A incidents, Primary Care OOH services and ED attendances.