The 4 minor changes to the methodology agreed with the ERIC Group are
Discharge date (DISDATE)
When selecting the discharge events, the method previously included a restriction that spells needed to have an admission date which fell within the reporting year. This excluded discharges where the admission occurred before the reporting year.
Analysis of the dataset showed that this definition reduced the number of discharge spells in the sample by 0.7%.
As part of the purpose of the indicator is to measure the quality of the discharge, this restriction has been lifted so that the indicator includes all discharges in the reporting year.
Method of discharge (DISMETH)
The method previously included discharges where the method of discharge (DISMETH) equalled 2 (“self-discharged or discharged by a relative or advocate”).
As one of the purposes of the indicator is to improve the quality of the discharge by the hospital it was agreed that this discharge method was not within the provider’s control and so they shouldn’t be measured against it. This change also brings the method in line with the approach taken by the Secondary Uses Service (SUS).
Analysis showed that this change reduced the number of spells in the sample by 188,000 or 0.8% of the total for 2018/19.
TRETSPEF
Previously the indicator used MAINSPEF (defined as “the specialty under which the consultant is contracted”) to define the specialty of treatment.”
The secondary care team within NHS Digital recommended that the treatment function specialty, TRETSPEF, (defined as “the specialised service within which the patient was treated” would be more appropriate to use.
The field is used within the indirect standardisation calculation to define whether the discharge is categorised as surgical or medical.
This field was also previously used in the definition of obstetrics where main specialty was in 501, 560 or 610 and excluded at most 322,572 continuous inpatient (CIP) spells in 2017/18. Using treatment specialty in this instance would have excluded 380,463 CIP spells in the same year.
Relaxation of admission filters
Historically a readmission event was excluded from the dataset if it did not have a valid age or sex value.
The importance of the admission is that it happened and that it could be a readmission event. It is not relevant whether the record is complete. These fields are not used in any subsequent calculation such as the standardisation categories as these are derived from the preceding discharge event.
Therefore, the requirement for the admission to have a valid age and sex has been removed.
The impact of these changes is treated as a group in the analysis below.