In the first instance, a date stamp (or event date) is attached to each record from source data that has triggered an addition to the baseline SPL. These data are collated in a fact table, or audit log.
The fact table includes 3 new data items, data source, risk flag and date. The risk flag is calculated as “High”, “Medium” or “Low”; or “H”, “M” or “L” for ease.
For any record that triggers inclusion through the algorithm, the risk flag is set to “H” with appropriate data source and data also recorded.
Subsequent (non-algorithmic) additions and subtractions will be processed, by date, as follows:
Action |
Outcome |
GP marks a new SPL patient as low risk |
The patient is not included in the composite SPL |
GP marks a new SPL patient as medium risk |
The patient is not included in the composite SPL |
GP marks a new SPL patient as high risk |
The patient is added to the composite SPL |
GP marks an existing SPL patient as low risk |
The patient is removed from the composite SPL |
GP marks an existing SPL patient as medium risk |
The patient is removed from the composite SPL |
GP marks an existing SPL patient as high risk |
The patient is retained in the composite SPL |
NHS Trust “adds” a new SPL patient |
The patient is added to the composite SPL |
NHS Trust “adds” an existing SPL patient |
The patient is retained in the composite SPL |
NHS Trust “subtracts” an existing SPL patient |
The patient is removed from the composite SPL |
NHS Trust “subtracts” a non-SPL patient |
The patient is not included in the composite SPL |
In formulaic terms, actions and outcomes can be presented as follows:
Source |
Current risk flag |
Action |
New risk flag |
SPL outcome |
GP |
<BLANK>, L or M |
L |
L |
Not included |
GP |
<BLANK>, L or M |
M |
M |
Not included |
GP |
<BLANK>, L or M |
H |
H |
Added |
GP |
H |
L |
L |
Removed |
GP |
H |
L |
L |
Removed |
GP |
H |
H |
H |
Retained |
NHS Trust |
<BLANK>, L or M |
Addition |
H |
Added |
NHS Trust |
H |
Addition |
H |
Retained |
NHS Trust |
H |
Subtraction |
L |
Removed |
NHS Trust |
<BLANK>, L or M |
Subtraction |
L |
Not included |
The GP Clinical decision will always take priority in terms of subtractions and only newer eligible coded diagnoses will override this existing clinical decision. In practice this will only ever be from General Practice data, as HES data will generally be a period of time behind.
If there is a conflict in the SPL fact table between same dated methodology, a hospital or a GP update record, (i.e. diagnostic codes or risk codes have been applied with an identical date) the priority will be the GP clinical decision.