Long-stay patients: frequently asked questions Published by NHS England and NHS Improvement Updated August 2018 1
Document Title: Long-stay patients: frequently asked questions Version number: 1.0 First published: 9 July 2018 Updated: 17 August 2018 Prepared by: Operational Information for Commissioning, NHS England Classification: OFFICIAL This information can be made available in alternative formats, such as easy read or large print, and may be available in alternative languages, upon request. Please contact the OIC (Central) at: england.nhsdata@nhs.net. 2
Methodology What is a long-stay patient? A long-stay patient is defined as an adult patient who has been in an acute bed for 21 days or longer. A full definition of CDS fields can be found in the long-stay patient methodology document. How were the baselines calculated? Trust baselines were calculated using 2017/18 SUS+ data. The total number of longstay days (day 21+) in the year was divided by 365 to give the average number of beds occupied by patients who had been in an acute bed for at least 21 days. Further details of this calculation can be found in the long-stay patients methodology document. How were the targets calculated? Using the 2017/18 baselines, acute trusts were split into five groups using the quintiles of long-stay rate (long-stay days divided by total bed days). Each group has been given a % reduction target that together will reduce long stays by at least 25% nationally. These targets have been applied to trust baselines to give a target number of occupied long-stay beds. Further details of the methodology can be found in the long-stay patients methodology document. Where can I find the methodology document in the dashboard? Click the (i) icon at the top right: it will take you to the list of available documents. Technical and methodology guidance can also be found on the NHS Improvement long stays webpage: https://improvement.nhs.uk/resources/long-stays-dashboard/ Does the acute trust need to deliver all the reductions, or will other organisations be asked to contribute? Baselines and targets have been set at an acute trust level; however, we expect trusts to work with partner organisations to deliver the reductions. A view of the required reductions by clinical commissioning group and local authority is now also available. Our trust has a more complex casemix with several patients requiring long-term acute care. Will our targets be adjusted? No, adjustments for casemix will not be made as all trusts are being monitored against their own position last year. We expect all trusts can reduce their number of long-stay patients. 3
How are we measuring reductions in harm? That is one of the headline policy objectives but is absent from the dashboard metrics - we appear to have just jumped to A&E performance? There is strong evidence that long stays in hospital lead to patient deconditioning, harm to patients and unnecessary additional demands on health and care services. Tackling long stays in hospital will reduce harm, disability and cost. Of the 300,000 patients who spend over three weeks in hospital around 5-20% are medically unwell; 15-20% are patients who require an alternate level of care from another provider not available; and 60-80% are patients whose extended length of stay could be avoided either at the point of admission or shortly after to avoid decompensating and long stay, or by addressing process failures further through the pathway. Addressing the largest cohorts would ultimately improve flow and deconditioning, resulting in a provider s A&E performance improving hence the metric. How are we capturing those patients who clinically require a hospital stay of more than 21 days - major trauma, traumatic brain injury, catastrophic strokes, etc? All patients, regardless of condition, are counted within the baseline and there are no plans to exclude them. It is important to note that the ambition does not expect providers to eradicate all 21+ day stays; however, reductions can still be made for these complex patients, eg cutting LoS from 40 days to 35 days for these patients will help towards the ambition and to better patient care. When a patient has episodes under General & Acute specialties and non-g&a specialties within the same spell how is their length of stay calculated? Are you excluding the bed days under the non-g&a specialty? Or just using the specialty on admission/discharge and picking up the LoS of those patients? We use the discharge treatment function to identify whether the activity is acute; these patients are then included in the LoS calculations. When setting up the target was there a consideration for local health needs and demographic? For example, some areas have higher records of the elderly? Analysis of data has not shown much distinction between trusts in regard to demographics, so no adjustments have been made. It is important to remember that providers are only assessed against their own position from last year and not against peers. 4
We have a community neuro rehab unit that is currently included in our LoS figures. These patients have been discharged from the acute setting, should they be removed from our longer stay figures? If they have been removed from an acute setting their discharge treatment function should be a non-acute one. If we have included them it is because their SUS data is telling us those patients are still in an acute setting. The ambition When does the target need to be achieved by? The reduction needs to be achieved by December 2018. As the reduction is being monitored on a three-month rolling average basis, it will be assessed against the average for January to March 2019. How will progress be monitored? Progress will be monitored via NHS Improvement s long stays dashboard. Further details of the dashboard are available from https://improvement.nhs.uk/resources Formalised publication plans will be available soon. Accessing the dashboard How do I access the dashboard? A user guide on how to request access can be found on here: https://improvement.nhs.uk/resources/long-stays-dashboard/ Please follow the user guide but note that the dashboard link will not work for you if you don t have right permissions as detailed in the guide. Make sure you follow the steps in the guidance before emailing us as not doing so may cause unnecessary delays in getting you access. Communication Where do I send any queries about the dashboard? Please email your queries to nhsi.longstaysdashboard@nhs.net 5 OFFICIAL
When is the next webinar on the dashboard? We currently plan hold the next webinar in September. We ll notify you of dates via email communication from the longstaysdashboard account. Dashboard features Can I download data or print or add subscriptions from the dashboard? Currently the ability to download the data is from the dashboard is not available. However, the technical and methodology guidance documents should enable providers to recreate the data, these can be accessed here: https://improvement.nhs.uk/resources/long-stays-dashboard/ To note: we are able to provide SQL queries for NCDR users in NHS England. When is the dashboard data refreshed? Daily sitrep data is updated every 15 minutes each morning until 13:10 covering the previous 24 hours up until 8am that day (with the exception of A&E performance data submitted after a weekend or bank holiday, when it covers the previous 72 hours or longer). SUS+ NCDR A&E monthly and DToC data is available on a monthly basis, following the second Thursday after the month end, known as super stats Thursday. 0300 123 2257 enquiries@improvement.nhs.uk improvement.nhs.uk Publication code: IT 06/18 6