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Non-urgent A and E attendances

Summary

Analytics on non-urgent attendances to hospital emergency departments for care that could have been reasonably provided elsewhere.

The NHS Digital Innovative Uses of Data service has developed this report that looks at non-urgent attendances to hospital emergency departments. The definition of a non-urgent A and E attendance has been adopted from research conducted by the Centre for Urgent and Emergency Care Research (CURE), School of Health and Related Research, at the University of Sheffield.

According to this research a non-urgent attendance is defined as the "First attendance with some recorded treatments or investigations all of which may have been reasonably provided by a GP, followed by discharge home or to GP care."

Hospital Episode Statistics (HES) A and E data from April 2015 onwards have been used as the main source of data and feeds all the interactive visuals in this tool.  The data is classed as "management information". For official statistics on hospital activity please refer to Hospital Episode Statistics (HES).

How to use the reports

The reports are best used by expanding to full screen mode, using the diagonal arrows on the bottom right. To view the data behind the visual right-click on the data element in the visual such as a bar or a line or a dot and click ‘Show Data’. Alternatively use Alt+Shift+F11 on the keyboard on the selected visual or chart to view the data behind it.

 

The report above shows proportion of attendances that are non-urgent by trust and benchmarks it against its closest ten peers, peer average and national average. More information about the methodology used to identify the closest ten peer trusts can be found in the NHS Trust Peer Finder page.

The report below shows non-urgent attendances broken down to Sustainability and Transformation Partnership (STP) and Clinical Commissioning Group (CCG) level - users can drill-down from an STP of interest  to its Middle Layer Super Output Area (MSOA) level. STPs, CCGs and MSOAs divide the country geographically and into populations of approximately similar size, with STPs having a mean population of around 1.2 million, CCGs of around 0.25 million and MSOAs of around 8000.

The STP map shows the proportion of attendances that are non-urgent by STP - the darker the shade the higher the proportion for that STP. Hover over the STP of interest to see more information.

Click on the STP of interest on the map to see proportion of attendances that are non-urgent for the CCGs in the selected STP and the national average in the bar chart. Hover over CCGs in the bar chart to find more information about the CCG such as the CCG cluster for example. More information about the CCG clusters can be found in the ‘CCG clusters April 2017.xlsx’ which is a tool developed by NHS England.

Right-click on an STP of interest in the map and select ‘Drillthrough’ and ‘STP’. It displays a variety of information related to the selected STP.

Hover over the MSOA map to see the proportion of attendances that are non-urgent at MSOA level for the selected STP - the darker the shade the higher the proportion.

The GP map shows the practices where the patients making attendances that are non-urgent are registered - the darker the shade higher the number of non-urgent attendances from patients registered at the GP. The numbers displayed are rounded to the nearest five and practices with less than fifty attendances that are non-urgent are filtered out.

Click arrow on top left-hand corner of the page to return to the front page of the report with the STP map.

Definitions

The table below lists the filters applied to HES A and E data to identify non-urgent attendances.

Filters applied to HES A and E data to identify unnecessary attendances
HES A and E data attribute Codes
A and E Investigation: 2 character (INVEST2_NN) 06 = Urinalysis
21 = Pregnancy test
22 = Dental investigation
24 = None
A and E Treatment: 3 character (TREAT3_NN) 221 = Guidance/advice only - written
222 = Guidance/advice only - verbal
30 = Recording vital signs
56 = Dental treatment
57 = Prescription/medicines prepared to take away
99 = None (consider guidance/advice option)
07 = Prescriptions (retired code but still in use in some records)
Attendance disposal (AEATTENDDISP) 02 = Discharged - follow-up treatment to be provided by general practitioner
03 = Discharged - did not require any follow-up treatment
12 = Left department before being treated
Organisation Code (PROCODE3) Begins with R (NHS Trusts)
Attendance Category (AEATTENDCAT) 1 = First Accident and Emergency attendance
Arrival Mode (AEARRIVALMODE) not 1 = non-ambulance arrivals

Cases recorded as either having no investigations and/or treatments in emergency department or only receiving those included in the table above were included as non-urgent.

If a treatment or investigation field was blank, but at least one other treatment or investigation code was completed, then this was interpreted as no treatment or investigation. However, where all the treatment and investigation variables have blank codes, it is considered as an non-urgent attendance provided other inclusion criteria are met.

Notes and data sources

  1. All hospital data are sourced from HES A and E Commissioning Data Set.
  2. Final, published A and E data for the period April 2015 to March 2018 and provisional A and E data from April 2018 onwards have been used as the main source of data for this tool. 

  3. The MSOA to STP mapping has been created using data available via the Organisation Data Service.
  4. The MSOA values and boundaries displayed in the visuals in this report are based on the 2011 Census.
  5. Activity is aggregated at MSOA level. For MSOAs that relate to more than one STP the activity is split and aggregated accordingly.
  6. GP reference data was sourced from NHS Digital's Organisation Data Service.
  7. ONS CCG mid-2016 population estimates have been used to calculate the non-urgent attendance rate per 1000 population.

Suppression

The number of attendances, investigations or treatments are rounded to the nearest five. Further to that in the report showing data by:

  • trusts - number of attendances, investigations or treatments less than six are not displayed in the pie and donut charts
  • STPs and CCGs - practices with less that fifty attendances are not displayed in the map

Rates per head

Calculated as the number of attendances that are non-urgent expressed as a rate per 1,000 population

This management information report is experimental and feedback is welcomed.

Last edited: 8 April 2019 7:59 am