Three hospital trust indicators published to aid research into seven-day NHS provision

NHS Digital must be quoted as the source of these figures

Hospital trust level data are available within this report

26 October 2016: The experimental statistics presented in Seven-day Services, England, April 2015 - March 2016 provide a starting point for discussions on how to effectively measure improvement and variation in care provision across the week.

The report, published today by NHS Digital, is presented at trust level and includes the following indicators for the period between 1 April 2015 and 31 March 2016:

•  Mortality within 30 days of admission by week-part² of admission to hospital
•  Emergency readmissions within seven days of discharge from hospital by day of discharge
•  Length of stay following an emergency admission to hospital by day of admission

Users of these statistics are invited to comment on the findings published alongside this report and to consider how this information can be used to improve care, and how NHS Digital can develop these statistics to provide better information to drive improvements in care.

Please note, it is not possible to rank hospital trusts based on the outcomes in this report.

Mortality³

The indicator compares the odds of mortality within 30 days of admission for patients admitted at the weekend to the odds of mortality within 30 days of admission for patients admitted midweek. Results comparing the transition period (Monday and Friday) to midweek are also provided as contextual information.

If variation exists across the week for a particular trust, it should be examined in more detail to understand the causes. The indicator requires careful interpretation and should be used in conjunction with other indicators and information from other sources that together form a holistic view of trust outcomes.

Adjustments for various patient characteristics are included in the methodology. However, there may be differences in the characteristics of patients admitted at the weekend compared to midweek that it is not possible to identify and adjust for. This analysis cannot identify the reasons for any differences in the likelihood of mortality following an admission at the weekend compared to midweek.

Both emergency and non-emergency admissions are included and the results are presented as odds ratios⁴. The analysis does not attempt to identify whether or not a death was avoidable.

Emergency readmissions

The indicator compares the odds of an emergency readmission within seven days for patients discharged on a particular day of the week to the odds of an emergency readmission within seven days for patients discharged on a Wednesday⁵.

Adjustments for various patient characteristics are included in the methodology. However, there may be differences in the characteristics of patients discharged at the weekend compared to midweek that it is not possible to identify and adjust for.

The indicator does not attempt to identify whether the emergency readmissions were avoidable and, like the mortality indicator, the results are presented as odds ratios.

Length of stay

The median length of stay⁶ by day of admission to hospital is presented, along with the proportion of provider spells⁷ with a length of stay of 0, 1, 2, 3, and 4 or more days.

At this time, no adjustments for patient characteristics have been applied to this indicator.

Length of stay information is only available once a patient has been discharged and so this analysis is limited to provider spells in the Hospital Episode Statistics (HES)⁸ dataset with a discharge date between 1 April 2015 and 31 March 2016, where the patient was admitted in an emergency.

Read the full report and guidance at: https://digital.nhs.uk/data-and-information/publications/clinical-indicators/seven-day-services

ENDS

1. NHS Digital is the national information and technology provider for the health and care system. Our team of information analysis, technology and project management experts create, deliver and manage the crucial digital systems, services, products and standards upon which health and care professionals depend. Our vision is to harness the power of information and technology to make health and care better. NHS Digital is the new trading name for the Health and Social Care Information Centre (HSCIC). We provide 'Information and Technology for better health and care'. Find out more about our role and remit at www.digital.nhs.uk

2. For this indicator, the week is divided into the following three week-parts: midweek (Tuesday, Wednesday and Thursday), weekend (Saturday and Sunday) and transition (Monday and Friday).

3. The methodology used in the mortality indicator was developed, and is owned, by University Hospitals Birmingham NHS Foundation Trust. It is based on the methodology presented in Freemantle N, Ray D, Mcnulty D, et al. Increased mortality associated with weekend hospital admission: a case for expanded seven day services? BMJ 2015; 351: h4596.

4. Odds ratios which are greater than one indicate an increased likelihood of mortality compared to the reference category (midweek) while odds ratios which are less than one indicate a decreased likelihood of mortality compared to the reference category, holding all other characteristics constant. The comparison is strictly within the same hospital trust and is independent of the overall mortality rate for that trust. For example, a trust with a high odds ratio for admissions at the weekend compared to midweek may have a low overall mortality rate and vice-versa. Further information on how to appropriately interpret the indicator is available alongside this publication at https://digital.nhs.uk/data-and-information/publications/clinical-indicators/seven-day-services

5. For this indicator, comparisons are made between individual days of the week and Wednesday, the midpoint of the week.

6. Length of stay is a whole number which is calculated as the difference between the admission and discharge dates for the provider spell. HES data do not contain any information on the time of admission or discharge. The median represents the middle value when all values are placed in ascending order.

7. A provider spell is a continuous period of time spent as a patient within a single trust.

8. HES is a data warehouse containing details of all NHS funded admissions, outpatient appointments and A&E attendances at English hospitals. These data are collected during a patient's time at hospital and are submitted by trusts to allow them to be paid for the care they deliver. This publication uses provisional HES data for the financial years 2016-17 and 2015-16 and finalised HES data for earlier financial years.

9. For media enquires please contact [email protected] or telephone 0300 30 33 888.