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Provisional Accident and Emergency Quality Indicators: supporting information

Guidance on using the statistical publication Provisional Accident and Emergency Quality Indicators for England, with details of what is and is not included in the figures, information about ECDS and relevant footnotes and data quality.

Introduction

Figures in this report have been published using data submitted to the Emergency Care Data Set (ECDS) to compare England and providers in terms of the care quality indicators which investigates time spent in A&E. Data. This document gives a breakdown of field definitions and derivations used in the report, to produce the published statistics on A&E activity.

Monthly information on the indicators has been produced by NHS England (formally NHS Digital) since July 2012 (publication: Provisional A&E Hospital Episode Statistics data on the Accident & Emergency Clinical Quality Indicators for England). These data used HES A&E CDS010 up until March 2020, and from April 2020 use ECDS CDS011. Prior to July 2012, this information was produced by the Department of Health.

Since October 2017 providers who are required to submit national patient level A&E activity to NHS England (formally NHS Digital) have been able to do so in one of two ways. Submitting data in the existing A&E CDS010 data format or alternatively by submitting to the new Emergency Care Data Set (ECDS) CDS011.  As of April 2020 all analysis and reports for emergency care use ECDS CDS011 as A&E CDS010 is now retired.

Please send queries or feedback via email to [email protected] using the title "Provisional Accident and Emergency Quality Indicators for England".

Author: Secondary Care Open Data and Publications, NHS England
Lead Analyst: Emily Michelmore


Experimental statistics

The statistics in this analysis are classified as experimental. Experimental statistics are official statistics which are published in order to involve users and stakeholders in their development and as a means to build in quality at an early stage. It is important that users understand that limitations may apply to the interpretation of this data.

Find out more about experimental statistics


Publication coverage

This publication only includes data for England NHS providers.

The measures included in this publication report on data coverage in ECDS compared with the emergency monthly situation reports MSitAE published by NHS England and NHS Improvement. They also report statistics for total time in A&E, time to assessment, time to treatment, A&E attendances that left before treatment and unplanned reattendances within 7 days. Each report contains national figures and provider level figures.

The data included in this report are sourced from Provisional ECDS (Emergency Care Data Set) data submitted to SUS (Secondary Uses Service) on a monthly basis to reflect the monthly SUS submission inclusion dates. The publication includes data for the latest month available and the previous 23 months - provisional ECDS data may be revised throughout the financial year and each publication will report on the latest month and refreshed data for the previous months until it is finalised at the end of the financial year.


Provisional data

For data in the current financial year:

The data are provisional and may be incomplete or contain errors for which no adjustments have yet been made.  Counts produced from provisional data are likely to be lower than those generated for the same period in the finalised end of year data set. This shortfall will be most pronounced in the final month, weeks, or days in the reporting period. It is also probable that clinical data are not complete, which may affect the latest weeks of any given period. There may also be errors due to coding inconsistencies that have not yet been investigated and corrected.

ECDS data is finalised at the end of the financial year (April to March) and released as an annual publication.

ECDS data may be submitted daily. This report is based on a cut taken on the monthly SUS inclusion date inline with other monthly CDS reporting.  Open the timetable for SUS inclusion dates


Suppression methodology

This publication follows standard methodology for secondary care publications in England.  

To reduce the risk of identifying individuals from small numbers, 0 with Y suppression flag appears in the tables for all sub-national breakdowns, where it is possible to calculate a value between 1 and 7 from the data presented. All other sub-national data has been rounded to the nearest 5 for ECDS based measures only.

Percentages - when calculating percentages at sub-national level:

1.  Where the numerator or denominator is between 1 and 7 (inclusive), no percentage or rate is calculated, and 0 with Y suppression flag will be displayed.

2. Where the numerator is zero, the percentage will be 0%.

3.  Where the unrounded numerator and denominator are greater than or equal to 8, a percentage or rate is calculated using the rounded numerator or denominator.

HES and ECDS outputs produced by the Secondary Care Analysis team will therefore only display a calculated percentage to the nearest whole number where the rounded denominator is greater than or equal to 400.

All calculations are completed on unrounded figures.


Measures included

Metadata explaining the measures is released alongside the open data csv file and interactive dashboard. The measures included are:

MSitAE (situation reports) Comparison

Left Department before Treatment

Time to Initial Assessment

Time to Treatment

Total Time in A&E

Unplanned Reattendances


Footnotes

Total number of attendances in ECDS

The total number of attendances in ECDS at Provider level will not always be the same across the different measures, due to different filters being applied. The total number of attendances in ECDS at England level will also differ for the reason above, and additionally to the different number of providers in each measure. Information about the filters applied to each measure can be found in the metadata file.

Further information about discharge codes used in ECDS can be found in the ECDS User Guide

Monthly Situation Reports

A&E Attendances and Emergency Admissions Monthly Situation Reports (MSitAE), collected by NHS England and NHS Improvement, are the official source of A&E information, including the 4 hour total time standard. ECDS counts may differ from MSitAE but ECDS enables the comparisons across the different filters available. This report is not intended for any official performance monitoring use.

Excluded activity

For this publication, planned follow-up attendances and non-applicable attendances or dead on arrival are excluded from the measures. In the metadata this is captured as:

Filter: ATTENDANCE_CATEGORY equals: (1) (2) or (3) or is null.

Streamed activity

February 2023: We are currently looking into activity which is streamed to and from urgent treatment centres captured in ECDS. Streamed activity is currently removed from the measure UNPLANNED_REATTENDANCES. It is not removed from other measures and the impact is currently being investigated. When guidance is finalised about how to identify and analyse streamed activity other than reattendances, we will inform users about the methodology and impact on data within ECDS and this publication.


Data quality

Detailed information about ECDS data quality is published monthly online

Please note the following for this publication:

Calculating time in emergency departments

We are aware that there is a potential data quality issue whereby a small number of attendances that last over 24 hours are not being reported as such. This is being investigated as it is believed that in some instances incorrect values may have been submitted for arrival and departure dates.

From 2022-23 M4 an updated methodology has been used to calculate patient time spent on A&E wards. Previously, attendances with a departure time less than their arrival time were assumed to have been completed the day after the day of arrival and length of stay was calculated accordingly. This limited the maximum recorded wait times to 24 hours.

Under the updated methodology, the date of departure, assessment or date seen is now measured against the arrival date, so some patients may have a total recorded time in an accident and emergency ward of more than 24 hours. In some instances, this may reflect what is best for the patient e.g. it may be safer for certain patients who are awaiting a placement elsewhere, to be kept in A&E rather than admitted to an inpatient ward.

Through work with providers, it has been found that calculated figures of more than 72 hours are commonly data quality issues due to recording errors. These have therefore been excluded from calculating average or maximum wait times, indicated in the metadata.

Impact of the cyberattack August 2022

As a consequence of the NHS cyber attack last year, certain providers have been unable to submit complete A&E data. The data used to produce this report are therefore incomplete and there may be undercounts in certain figures. We are currently in the process of identifying affected providers and rectifying the issue. 


Open data format

In March 2023, the publication was updated following user research and evaluation to follow open data standards and improve the usability of the publication. The following files are included in the publication:

Open data csv

Column Description Values
ATTENDANCE_MONTH Month the attendance was recorded captured as YYYY-MM 2023-01
PROVIDER_CODE Code to identify the provider of activity AAH
PROVIDER_NAME Name to identify the provider of activity TETBURY HOSPITAL TRUST LTD
MEASURE_ID Identifier for the measure AEQI011
MEASURE_NAME Descriptive name of the measure MSITAE_COMPARISON_ECDS
MEASURE_VALUE Numeric value 100
SUPPRESSION Flag indicating is the measure value has been suppressed (measure value will be 0) Y

Metadata (information about the measures)

Column Description
MEASURE_ID Identifier for the measure used in the open data csv (files can be joined on this ID)
MEASURE_NAME Descriptive name of the measure used in the open data csv
DESCRIPTION Text description of the measure including what is being calculated
DATA_TYPE Data type of the measure value
CAVEATS Short text description of caveats relevant to the measure, more information can be found on this webpage
SPECIFICATION Explanation of the query ran to produce the measure including technical details

Interactive dashboard (Power BI)

Our interactive dashboard steps through the measures with a timeseries and it allows the data to be easily filtered by provider. The data is presented in charts and tables and the underlying data can be found in the open data csv.

 

Coded information

Further details about coded information used to calculate the measures are shown below

Field Description of coded information
Department Type - 
A classification of Emergency Care department types according to the activity carried out.  

01-- Emergency departments are a CONSULTANT led 24 hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency PATIENTS

02-- Consultant led mono specialty accident and emergency service (e.g. ophthalmology, dental) with designated accommodation for the reception of PATIENTS

03-- Other type of A&E/minor injury ACTIVITY with designated accommodation for the reception of accident and emergency PATIENTS. 

04-- NHS walk in centres

Attendance Category - 
Indicates whether a patient is making an initial or follow-up attendance within a particular A&E Department.

1-- Unplanned First Emergency Care Attendance for a new clinical condition (or deterioration of a chronic condition).

2-- Unplanned Follow-up Emergency Care Attendance for the same or a related clinical condition and within 7 days of the First Emergency Care Attendance at THIS Emergency Care Department

3-- Unplanned Follow-up Emergency Care Attendance for the same or a related clinical condition and within 7 days of the First Emergency Care Attendance at ANOTHER Emergency Care Department

4-- Planned Follow-up Emergency Care Attendance within 7 days of the First Emergency Care Attendance at THIS Emergency Care Department

X-- Not Applicable/Patient dead on arrival

Arrival Method - 
The method by which a patient arrived at an A&E department. 

SNOMED CT and SNOMED Descriptions:

1048071000000103-- Arrival by own transport (finding)

1048061000000105-- Arrival by public transport (finding)

1048031000000100-- Arrival by emergency road ambulance (finding)

1048041000000109-- Arrival by emergency road ambulance with medical escort (finding)

1048021000000102-- Arrival by non-emergency road ambulance (finding)

1048051000000107-- Arrival by helicopter Air Ambulance (finding)

1048081000000101-- Arrival by medical repatriation air ambulance (finding)

1047991000000102-- Arrival by prison transport (finding)

1048001000000106-- Arrival by police transport (finding)

Discharge Status - 
The status of the PATIENT on discharge from an Emergency Care Department. 

SNOMED CT and SNOMED Descriptions:

182992009-- Treatment completed (situation)

1077021000000100-- Streamed from emergency department to general practitioner following initial assessment (situation)

1077031000000103-- Streamed from emergency department to urgent care service following initial assessment (situation)

1077781000000101-- Streamed to emergency department following initial assessment (situation)

1077081000000104-- Streamed from emergency department to ambulatory emergency care service following initial assessment (situation)

1077091000000102-- Streamed from emergency department to falls service following initial assessment (situation)

1077101000000105-- Streamed from emergency department to frailty service following initial assessment (situation)

1077041000000107-- Streamed from emergency department to mental health service following initial assessment (situation)

1077071000000101-- Streamed from emergency department to pharmacy service following initial assessment (situation)

1077051000000105-- Streamed from emergency department to dental service following initial assessment (situation)

1077061000000108-- Streamed from emergency department to ophthalmology service following initial assessment (situation)

1066301000000103-- Left care setting before initial assessment (finding)

1066311000000101-- Left care setting after initial assessment (finding)

1066321000000107-- Left care setting before treatment completed (finding)

63238001-- Dead on arrival at hospital (finding)

75004002-- Emergency room admission, died in emergency room (procedure)

Discharge Follow Up - 
the SNOMED CT® concept ID which is used to identify the SERVICE to which a PATIENT was referred for continuing care following an Emergency Care Attendance.

SNOMED CT and SNOMED Descriptions:

989501000000106-- Discharge from Accident and Emergency service with advice for follow up treatment by general practitioner (procedure)

306170007-- Referral to physiotherapy service (procedure)

306735003-- Referral to general dental surgery service (procedure)

183584001-- Referral to community psychiatric nurse (procedure)

710915002-- Referral to community service (procedure)

301791000000104-- Referral to fracture clinic (procedure)

898791000000105-- Referral for ambulatory care (procedure)

1066111000000103-- Referral to outpatients department (procedure)

1077181000000100-- Follow-up review in emergency department (finding)

266747000-- Referral to private doctor (procedure)

3780001-- Routine patient disposition, no follow-up planned (procedure)

description of the measure including what is being calculated
Discharge Destination - the SNOMED CT® concept ID which is used to identify the intended destination of the PATIENT following discharge from the Emergency Care Department.

SNOMED CT and SNOMED Description:

306689006-- Discharge to home (procedure)

306691003-- Discharge to residential home (procedure)

306694006-- Discharge to nursing home (procedure)

306705005-- Discharge to police custody (procedure)

50861005-- Patient discharge, to legal custody (procedure)

1066331000000109-- Emergency department discharge to emergency department short stay ward (procedure)

1066341000000100-- Emergency department discharge to ambulatory emergency care service (procedure)

1066351000000102-- Discharge to hospital at home service (procedure)

306706006-- Discharge to ward (procedure)

1066361000000104-- Emergency department discharge to high dependency unit (procedure)

1066371000000106-- Emergency department discharge to coronary care unit (procedure)

1066381000000108-- Emergency department discharge to special care baby unit (procedure)

1066391000000105-- Emergency department discharge to intensive care unit (procedure)

1066401000000108-- Emergency department discharge to neonatal intensive care unit (procedure)

19712007-- Patient transfer, to another health care facility (procedure)

183919006-- Urgent admission to hospice (procedure)

305398007-- Admission to the mortuary (procedure)

Patient Type (admitted or non-admitted)

When DISCHARGE_DESTINATION is equal to one of the following SNOMED codes then Patient Type is 'Admitted': 1066331000000109, 1066341000000100, 1066351000000102, 306706006, 1066361000000104, 1066371000000106, 1066381000000108, 1066391000000105, 1066401000000108, 19712007, 183919006.

 

When Discharge Destination is not equal to any of the above SNOMED codes then Patient Type is 'Non-Admitted'.

 


Frequently asked questions

How to filter the csv to see national data

The column PROVIDER_CODE can be filtered to ENG, the code for England. This will show the measure values aggregated to provide a national total

How to see the data similar to the excel format

The open data csv can be pivoted to produce table formats. For example, to create a national summary table, we suggest

  • row value = ATTENDANCE MONTH
  • column value = MEASURE_ID
  • values = MEASURE_VALUE
  • filters = PROVIDER_CODE filtered to “ENG”

We are continuing to improve publications, please let us know if you have any feedback.

Last edited: 14 December 2023 11:00 am