TRUTH, LIES AND NHS STATISTICSDR GERRY MORROWCLARITY INFORMATICS7TH FEBRUARY 2017

ACCIDENT AND EMERGENCY

WEEKEND MORTALITY

ACCIDENT AND EMERGENCY

Lies • Patients should go somewhere else or ‘channel shift’• Lots of patients are inappropriately attending A&E • GPs should stay open longer

ACCIDENT AND EMERGENCY

Lies • Patients should go somewhere else or ‘channel shift’• Where should they go? – Type 1,2 and 3 units • GP?• Pharmacist?• Self-care?

ACCIDENT AND EMERGENCY - ATTENDANCES

ACCIDENT AND EMERGENCY Issues – what is an inappropriate attendance? • 13% discharged without treatment• 35% guidance or advice• 16.8% may be ‘inappropriate’What if GPs stayed open longer?• GP survey, 4% went to A&E as they could not get a ‘workable’ appointment• BUT those attending ‘inappropriately’ had x2 GP appointments, x10 OOH

contacts, and statistically significant markers for anxiety and depression• What about uncovering unmet need?

ACCIDENT AND EMERGENCY - ADMISSIONSIssues – what about number of admissions?

ACCIDENT AND EMERGENCY • Direct correlation between need for admission and length of

‘trolley’ wait• Direct correlation between age and length of ‘trolley’ wait (149

minutes < 75, 213 minutes >75)• Case mix in A&E has shifted to an older age group• Direct correlation between hospital occupancy rates and length

of ‘trolley’ wait• Greatest activity in A&E is during working hours • More admissions = busier A&E

WEEKEND MORTALITY

Lies • Higher in-hospital death rates at weekends• 7 day NHS will reduce death rates• New junior doctor contract will reduce death rates • Mid Staffs would not have happened if junior doctors worked

new contract

WEEKEND MORTALITY

Lies • Higher in-hospital death rates at weekends• Freemantle et al 2015 BMJ ‘there are around 11,000 excess deaths in

hospitals every year among patients admitted on a Friday, Saturday, Sunday or Monday compared with other days of the week. The authors included the effect of Fridays and Mondays as ‘appropriate support services in hospitals are usually reduced from late Friday through the weekend, leading to disruption on Monday morning’

WEEKEND MORTALITY

Truth • Inconsistent coding• Case mix adjustment for co-morbidity• Case mix adjustment for severity of illness

WEEKEND MORTALITY Lies • 7 day NHS will reduce death rates

Truth ‘The results of the various recent studies do not mean there is no weekend effect, only that if care provided during weekends is poorer than on weekdays, it does not result in patient deaths. This should come as no surprise given that death is not a particularly sensitive measure of the overall quality of hospital care, as approximately 4*% of hospital deaths are thought to be avoidable.’ Black 2016 JAMA

• *NE data = 0.6% avoidable deaths

WEEKEND MORTALITY

Lies • New junior doctor contract will reduce death rates • Mid Staffs would not have happened if junior doctors worked new contractTruth‘policymakers need to avoid unjustified claims about an increased risk of death among patients admitted during weekends because doing so only serves to undermine public confidence and trust in hospitals and damage staff morale. Neither of these are in the interest of patients or the public’.

CLARITY INFORMATICS

• Experts in data, analytics and health informatics

PERCEPTION AND TRUTH

REFERENCES

Quality Watch ‘Focus on A&E attendances’. Blunt 2014http://www.qualitywatch.org.uk/sites/files/qualitywatch/field/field_document/QW%20Focus%20on%20A%26E%20attendances%20%28for%20web%29.pdfJ Health Serv Res Policy. 2002 Jul;7(3):160-5.'Inappropriate' attendance at an accident and emergency department by adults registered in local general practices: how is it related to their use of primary care? https://www.ncbi.nlm.nih.gov/pubmed/12171746/

• JAMA December 27, 2016 Volume 316, Number 24 (Higher Mortality in Weekend Admissions Black N.