Hospital guide methodology

The Dr Foster Hospital Guide provides information on NHS acute hospitals with more than 300 beds, some smaller NHS acute hospitals that provide key services to a geographical area and selected specialist hospitals.

Acute and Specialist hospitals are run by NHS Trusts in England and Wales, Health and Social Services Trusts in Northern Ireland, and by NHS Boards in Scotland. A trust or board may run one or more hospitals depending on its location. The information in this guide can be at trust/board level or hospital level, depending on how it has been collected.

About the indicators

There are a number of different clinical indicators in the hospital guide presented for a range of clinical procedures. This section provides more detailed information on how the various indicators are calculated, where the data comes from and what time periods are covered.

Procedural Scorecard Indicators

Length of Stay

Metric

Average number of days spent in an acute trust for planned treatment.

Numerator

The total number of days in elective inpatient spells, at an acute trust for a given main procedure.

The difference between the date of discharge and date of admission is used to determine the interval of stay within the trust (days after possible transfers from the trust are not included). Day cases are omitted from the calculation (a day case is an inpatient spell where the patient is not intended and does remain overnight).

Denominator

A count of the number of elective spells occurring at a trust (NHS) or a site (IS) during the current extract period. A count of the number of elective spells occurring at a provider during the extract period.

Data Source

Commissioning Data Sets (CDS)

Time frame

December 2008 - November 2009

Basis

Acute Trust

Statistical methods used

The indicator is a statistical mean (average) of the raw days spent in hospital: the total number of days accruing from finished spells, divided by the number of spells. It is not standardised.

National median

A national median length of stay for each relevant procedure is calculated by arranging the length of stay for all relevant spells (elective spells in NHS acute hospitals in England) in ascending order to identify the middle value; where there are an even number of values, an average of the two central values is taken.

Relative risk of Readmission

Metric

A ratio of the observed number of emergency readmissions at a given trust to the expected number of 28-day readmissions for a particular procedure.

Numerator

The total number of emergency readmissions resulting from inpatient spells at an acute trust for a given procedure. The emergency readmission must occur within a 28-day period - 0-28 days inclusive - from the discharge date of the originating spell.

Denominator

The expected number of emergency readmissions resulting from every finished inpatient spell at an acute trust for a given procedure where the procedure is the main procedure in the spell.

The expected number of readmissions is obtained by modelling the risk of readmission.

Each inpatient spell has a risk of readmission associated with it based upon deprivation, sex, age, co-morbidity, the number of emergency admissions a patient has had in the previous 12 months and the presence of a palliative care episode. The risks are summed to obtain the overall expected number of readmissions.

Data Source

Commissioning Data Sets (CDS)

Time frame

December 2008 - November 2009

Basis

Acute Trust

Statistical methods used

Logistic regression models of readmissions are built from all years of HES data from 1996/7 onwards based upon the available case-mix factors. The factors adjusted for are: age, sex and method of admission (non-elective or elective), year of admission, deprivation quintile, the Charlson index of comorbidity (see for example, Sundararajan et al, Journal of Clinical Epidemiology 2004; 57: 1288-1294, available via ScienceDirect), the number of emergency admissions a patient has had in the previous 12 months and the presence of a palliative care episode. Based upon these parameters a logistic regression model is developed which predicts the risk of readmission for an inpatient spell.

A 97.5% confidence interval is calculated for the indicator using Byar's approximation. The confidence interval enables a banding of the indicator for comparison purposes.

Banding

Relative risk is not a quantitative benchmarking measure. It is not intended to give exact readmission rates for a procedure, it is designed to highlight and show where a trust's readmission is not in line with outcomes nationwide.

There are three reported bands:

if the lower limit of the confidence interval is greater then 100 then the assigned band is red, "more than expected"
if the upper limit of the confidence interval is less then 100 then the assigned band is red, "less than expected"
otherwise, the assigned band is blue, "as expected"

One-year revision rates for primary hip and knee replacements

Metric

The proportion of joint replacements with a revision procedure within 365 days of the initial (index) procedure, over the total number of joint replacements carried out at the trust over a three year period.

Three years of index procedures are combined to provide sufficient numbers at trust level. A further year of data is needed to allow a year's follow-up for every index procedure. Index operations in 2004/5 to 2006/7 give rise, potentially, to revisions between 2004/5 and 2007/8.

Note that only one revision within 365 days per patient is counted (some people can have several), and revisions are matched to side of index procedure (right or left).

Construction

Index procedure codes for primary total hip replacement (THR)

Codes: oper1 in ('W371','W381','W391') or (oper1='W581' and (oper2='Z843' or oper3='Z843' or oper4='Z843'))

Description: These cover primary total replacement including resurfacing procedures. For the latter, the Z code is required in any secondary op field (oper2-oper12 - only 2 to 4 shown above for brevity) to specify hip.

Revision procedure codes for THR

Codes: oper1 in ('W373','W383','W393', 'W372','W374', 'W382','W384','W392','W394') or (oper1='W582' and (oper2='Z843' or oper3='Z843' or oper4='Z843')) or oper2 in ('W580', 'W370', 'W380', 'W390') or oper3 in ('W580', 'W370', 'W380', 'W390') or oper4 in ('W580', 'W370', 'W380', 'W390');

Description: These cover revisions (primary op field), conversions (in any secondary op field) and "attention to joint" (primary op field).

Index procedure codes for primary total knee replacement (TKR)

Codes: oper1 in ('W401','W411','W421') or (oper1='W581' and (oper2='Z846' or oper3='Z846' or oper4='Z846'))

Description: These cover primary total replacement including resurfacing procedures. For the latter, the Z code is required in any secondary op field to specify knee.

Revision procedure codes for TKR

Codes: oper1 in ('W403','W413','W423', 'W402','W404', 'W412','W414', 'W422','W424') or (oper1 in ('W580','W582') and (oper2='Z846' or oper3='Z846' or oper4='Z846')) or oper2 in ('W400', 'W410', 'W420') or oper3 in ('W400', 'W410', 'W420') or oper4 in ('W400', 'W410', 'W420')

Description: These cover revisions (primary op field), conversions (in any secondary op field) and "attention to joint" (primary op field).

Data Source

Commissioning Data Sets (CDS)

Time frame

April 2004 - March 2008

Basis

Acute Trust where index procedure took place.

Statistical methods used

Crude rate

Banding

Upper and lower control limits are calculated at 97.5% level of significance and these are used to band the crude rate.

There are three reported bands:

if the crude rate of revisions is greater than the upper control limit then the assigned band is red, "more than expected"
if the crude rate of revisions is less than the lower control limit then the assigned band is red, "less than expected"
otherwise, the assigned band is blue, "as expected"

Waiting time - Inpatient

Metric: By procedure, for elective care, the median wait time (elapsed number of days) between the decision to admit and the day of admission
Numerator: Not applicable.
Denominator: Not applicable.
Data Source: Commissioning Data Sets (CDS)
Time frame: December 2008 - November 2009
Basis: Acute Trust
Statistical methods used: The median is a statistical term that identifies the middle observation of a data set ordered in increasing value; where there is an even number of values, an average of the two central values is taken.
National median: An identical calculation the basis of which is national data (all English NHS Acute Trusts).

Waiting time - Outpatient

Metric

By specialty, the median wait time (elapsed number of days) for the first outpatient attendance following a GP referral.

In order to determine what specialty to show in relation to a procedure, we identify, nationally, all the discharge specialties that a procedure has been assigned to. We then identify the discharge specialty with the greatest number of spells assigned to it.

Numerator

Not applicable.

Denominator

Not applicable.

Data Source

Commissioning Data Sets (CDS)

Time frame

December 2008 - November 2009

Basis

Acute Trust

Statistical methods used

The median is a statistical term that identifies the middle observation of a data set ordered in increasing value; where there is an even number of values, an average of the two central values is taken.

National median

An identical calculation the basis of which is national data (all English NHS Acute Trusts).

Relative risk of inpatient admission

Metric

By procedure, a ratio of the observed number of inpatient admissions to the total number of all elective admissions (inpatient and day cases).

Numerator

By procedure, the total number of observed inpatient admissions.

Denominator

The expected number of inpatient admissions.

The expected number of admissions is obtained by modelling the risk of admission.

Each inpatient spell has a risk of admission associated with it based upon deprivation, sex, age, co-morbidity, the number of emergency admissions a patient has had in the previous 12 months and the presence of a palliative care episode. The risks are summed to obtain the overall expected number of inpatient admissions.

Data Source

Commissioning Data Sets (CDS)

Time frame

December 2008 - November 2009

Basis

Acute Trust

Statistical methods used

Logistic regression models of inpatient admissions are built from all years of HES data from 1996/7 onwards based upon the available case-mix factors. The factors adjusted for are: age, sex and method of admission (non-elective or elective), year of admission, deprivation quintile, the Charlson index of comorbidity (see for example, Sundararajan et al, Journal of Clinical Epidemiology 2004; 57: 1288-1294, available via ScienceDirect), the number of emergency admissions a patient has had in the previous 12 months and the presence of a palliative care episode. Based upon these parameters a logistic regression model is developed which predicts the risk of admission for an inpatient spell.

A 97.5% confidence interval is calculated for the indicator using Byar's approximation. The confidence interval enables a banding of the indicator for comparison purposes.

Banding

Relative risk is not a quantitative benchmarking measure. It is not intended to give exact admission rates for a procedure, it is designed to highlight where a trust's inpatient admissions are not in line with outcomes nationwide.

There are three reported bands:

if the lower limit of the confidence interval is greater then 100 then the assigned band is red, "more than expected"
if the upper limit of the confidence interval is less then 100 then the assigned band is red, "less than expected"
otherwise, the assigned band is blue, "as expected"

Hospital Standardised Mortality Ratio 1 year, 3 years and trend

Changes for 2009

A few ICD10 diagnosis codes have been moved between diagnosis groups. The only code with significant volume is I739 “Peripheral vascular disease, unspecified” which has been shifted from “Other circulatory disease” to “Peripheral and visceral atherosclerosis” - both groups are included in the HSMR.

In place of DFI’s own sub-groups which were designed specifically for mortality risk adjustment, we have adopted the official Clinical Classification System (CCS) sub-groups which have wider application and overall improve case-mix adjustment (see note below).

Full details of updates to the HSMR methodlogy can be found in the following document: HSMR Methodology 2010.

Charlson comorbidities

The original Charlson weights were derived about 25 years ago in the USA. We wanted to update them (e.g. HIV had the highest weight then but its mortality has fallen greatly since, particularly in hospitalised patients) and calibrate them on English data due to differences in coding practice and hospital patient population characteristics. We had advice from some clinical coders on current English coding practice and, where possible, also assessed the consistency of comorbidity recording among admissions for the same patient. As a result:

We have expanded the coding definition of some conditions such that more patients are identified as having those conditions.
Only secondary diagnoses (DIAG2-DIAG14) are now considered.
There is now greater variation in weights between conditions and the Charlson index (the sum of the weights) is treated as a continuous variable (limited to the range 0-50) for the purposes of risk adjustment.

Additional variables

Risks are adjusted for three additional variables:

Ethnicity (6 categories)
Source of admission (7 categories)
Month of admission

Metric

The ratio of the observed number of in-hospital deaths to the expected number of deaths, multiplied by 100.

Numerator

All spells culminating in death (method of discharge as death (DISMETH=4), defined by specific diagnosis codes for the primary diagnosis of the spell.

HSMR Diagnosis Groups

56 diagnosis groups which contribute to 80% of in-hospital deaths in England:

CCS group	Diagnosis
2	Septicemia (except in labour)
12	Cancer of oesophagus
13	Cancer of stomach
14	Cancer of colon
15	Cancer of rectum and anus
17	Cancer of pancreas
19	Cancer of bronchus, lung
24	Cancer of breast
27	Cancer of ovary
29	Cancer of prostate
32	Cancer of bladder
38	Non-Hodgkin's lymphoma
39	Leukaemias
42	Secondary malignancies
43	Malignant neoplasm without specification of site
55	Fluid and electrolyte disorders
59	Deficiency and other anaemia
68	Senility and organic mental disorders
100	Acute myocardial infarction
101	Coronary atherosclerosis and other heart disease
103	Pulmonary heart disease
106	Cardiac dysrthythmias
107	Cardiac arrest and ventricular fibrillation
108	Congestive heart failure, nonhypertensive
109	Acute cerebrovascular disease
114	Peripheral and visceral atherosclerosis
115	Aortic, peripheral, and visceral artery aneurysms
117	Other circulatory disease
122	Pneumonia
125	Acute bronchitis
127	Chronic obstructive pulmonary disease and bronchiectasis
129	Aspiration pneumonitis, food/vomitus
130	Pleurisy, pneumothorax, pulmonary collapse
131	Respiratory failure, in sufficiency, arrest (adult)
133	Other lower respiratory disease
134	Other upper respiratory disease
145	Intestinal obstruction without hernia
148	Peritonitis and intestinal abscess
149	Biliary tract disease
150	Liver disease, alcohol-related
151	Other liver diseases
153	Gastrointestinal haemorrhage
154	Noninfectious gastroenteritis
155	Other gastronintestinal disorders
157	Acute and unspecified renal failure
158	Chronic renal failure
159	Urinary tract infections
197	Skin and subcutaneous tissue infections
199	Chronic ulcer of skin
224	Other perinatal conditions
226	Fracture of neck of femur (hip)
231	Other fractures
233	Intracranial injury
237	Complication of device, implant or graft
245	Syncope
251	Abdominal pain

See Appendix: HSMR Diagnosis Codes

Denominator

Expected number of in-hospitals deaths derived from logistic regression, adjusting for factors to indirectly standardise for difference in case-mix for the 56 diagnosis groups.

Adjustments are made for:

Sex
Age on admission (in five year bands up to 90+)
Admission method (non-elective or elective)
Socio-economic deprivation quintile of the area of residence of the patient (based on the Carstairs Index)
Primary diagnosis (based on the Clinical Classification System - CCS group)
Co-morbidities (based on Charlson Score)
Number of previous emergency admissions
Year of discharge (financial year)
Palliative care (whether the patient is being treated in specialty of palliative care)

Exclude cases

Daycases (where classpat = 2 in the first episode)

Data Source

Commissioning Data Sets (CDS)

Time Frame

Where the HSMR is calculated over one year, the time frame is December 2008 - November 2009.

Where the HSMR is calculated over three years, the time frame is the financial years 2006/07, 2007/08, 2008/09.

Where the HSMR is displayed as a trend, the number of actual deaths in each of the financial years 2001/02 to 2007/08 is divided by the expected deaths for the financial year 2001/02.

Basis

Acute Trust

Statistical methods used

Logistic regression

The ratio is calculated by dividing the actual number of deaths by the expected number and multiplying the figure by 100. It is expressed as a relative risk, where a risk rating of 100 represents the national average. Where a trust has an HSMR of 100, it means that the number of patients who died is exactly as expected taking into account the standardisation factors. An HSMR above 100 means more patients died than would be expected; one below 100 means that fewer than expected died.

Control limits tell us the range of values that are consistent with random or chance variation. Data points falling within the control limits are consistent with random or chance variation and are said to display 'common-cause variation'; for data points falling outside the control limits, chance is an unlikely explanation and hence they are said to display 'special-cause variation' that is, where the trust's rate diverges significantly from the national rate.

Appendix

HSMR Diagnosis codes
CCS Group	Diagnosis name	ICD-10 Codes
2	Septicemia (except in labour)	A021,A207,A227,A267,A327,A392,A393,A394,A40,A41,A427,B007
12	Cancer of oesophagus	C15,D001
13	Cancer of stomach	C16,D002
14	Cancer of colon	C18,D010
15	Cancer of rectum and anus	C19-C21,D011-D013
17	Cancer of pancreas	C25
19	Cancer of bronchus, lung	C34,D022
24	Cancer of breast	C50,D05
27	Cancer of ovary	C56
29	Cancer of prostate	C61,D075
32	Cancer of bladder	C67,D090
38	Non-Hodgkin's lymphoma	C463,C82-C85,C963,C967,C969
39	Leukaemias	C901,C91-C95,D46
42	Secondary malignancies	C77-C79
43	Malignant neoplasm without specification of site	C80,C97,D099
55	Fluid and electrolyte disorders	E86,E87
59	Deficiency and other anaemia	D50-D56,D58-D61,D63,D64
68	Senility and organic mental disorders	F00-F09,F53,G30,G310,G311,R54
100	Acute myocardial infarction	I21,I22
101	Coronary atherosclerosis and other heart disease	I20,I24,I251,I252,I255-I259
103	Pulmonary heart disease	I26-I28
106	Cardiac dysrhythmias	I47,I48,I491-I499,R00
107	Cardiac arrest and ventricular fibrillation	I46,I490
108	Congestive heart failure, nonhypertensive	I50
109	Acute cerebrovascular disease	G46,I60-I64,I66
114	Peripheral and visceral atherosclerosis	I70,K55
115	Aortic, peripheral, and visceral artery aneurysms	I71,I72,I790
117	Other circulatory disease	I73,I77,I78,I791,I792,I798,I95,I988,I99,M30,M31,R03,R58,R943
122	Pneumonia	A202,A212,A221,A310,A420,A430,A481,A78,B012,B052,B250,B583,B59,B671,J12-J16,J170-J173,J178,J18,J850,J851
125	Acute bronchitis	J20-J22
127	Chronic obstructive pulmonary disease and bronchiectasis	J40-J44,J47
129	Aspiration pneumonitis, food/vomitus	J690
130	Pleurisy, pneumothorax, pulmonary collapse	J86,J90-J94,J981-J983,R091
131	Respiratory failure, insufficiency, arrest (adult)	J80,J96,R092
133	Other lower respiratory disease	A065,J81,J82,J84,J852,J853,J984,J986,J988,J989,J99,R042,R05,R061,R066,R093,R098,R230,R91,R942
134	Other upper respiratory disease	J30,J31,J33,J34,J37-J39,J980,J985,R040,R041,R048,R049,R060,R062-R065,R067,R068,R070,R49
145	Intestinal obstruction without hernia	K56
148	Peritonitis and intestinal abscess	K630,K65,K67
149	Biliary tract disease	K80-K83,K870,R932
150	Liver disease, alcohol-related	K70
151	Other liver diseases	A064,K710,K711,K717-K719,K72,K74,K750,K751,K758,K759,K76,K770,K778,R160,R162,R17,R18,R74,R945
153	Gastrointestinal haemorrhage	I850,K250,K252,K254,K256,K260,K262,K264,K266,K270,K272,K274,K276,K280,K282,K284,K286,K625,K920-K922
154	Noninfectious gastroenteritis	K52
155	Other gastrointestinal disorders	B054,K58,K590-K593,K598,K599,K631-K634,K638,K639,K66,K900-K902,K904,K908,K909,K928,K929,K93,R12-R15,R161,R19,R933,R935
157	Acute and unspecified renal failure	N17,N19
158	Chronic renal failure	N18,Z49
159	Urinary tract infections	N10,N11,N151,N158,N159,N16,N291,N30,N330,N34,N351,N37,N390,P393
197	Skin and subcutaneous tissue infections	A067,A201,A210,A220,A260,A311,A320,A363,A431,A441,A46,A480,B653,B781,B870,B871,L00-L03,L05,L08,L303,L444,L88,L946,L980,L983
199	Chronic ulcer of skin	L89,L97,L984
224	Other perinatal conditions	A33,P00-P04,P08,P221,P228,P229,P23-P28,P290-P292,P294-P299,P350,P351,P358,P359,P36,P371-P379,P38,P390-P392,P394-P399,P50-P53,P540-P545,P60,P61,P70-P95,P960,P961,P964-P969
226	Fracture of neck of femur (hip)	S720-S722
231	Other fractures	S12,S22,S32,S420,S421,S429,T021,T026-T029,T08,T142,T911,T912
233	Intracranial injury	S06,T060,T904,T905,T908,T909
237	Complication of device, implant or graft	T82-T87
245	Syncope	R55
251	Abdominal pain	R10

Mortality rate: Hip replacement

Metric

Relative risk of mortality within 30 days of a procedure, that is, the ratio of the observed number of deaths at a given trust to the expected number of 30-day mortalities for a particular procedure (this ratio is multiplied by 100).

Numerator

The total number of observed mortalities (in-hospital 30 days, 0-30 days inclusive) resulting from every finished inpatient spell at an acute trust for an elective Hip replacement procedure (the numerator is multiplied by 100).

The mortality must occur within 30 days of the date of the main procedure in the spell.

Denominator

The expected number of mortalities resulting from every finished inpatient spell at an acute trust for an elective Hip replacement.

The expected number of mortalities is obtained by modelling the risk of mortality using a logistic regression model. Each inpatient spell has a risk of mortality associated with it based upon deprivation, sex, age, co-morbidity. The risks are summed to obtain the overall expected number of mortalities.

Data Source

Commissioning Data Sets (CDS)

Time frame

April 2006 - March 2009

Basis

Acute Trust

Statistical methods used

Logistic regression models of the risk of post-operative mortality are built from all years of HES data from 1996/7 onwards based upon the available case-mix factors. The major factors adjusted for are: age, sex and method of admission (non-elective or elective), year of admission and deprivation quintile. Three further variables are included in the models: the Charlson index of comorbidity, the number of emergency admissions a patient has had in the previous 12 months and the presence of a palliative care episode. Based upon these parameters a logistic regression model is developed which predicts the risk of mortality for an inpatient spell. Since the admission events to a provider are (assumed) independent these risks are summed at the provider level for NHS Trusts, to yield the expected number of port operative (30 day) deaths. 99.8% (Poisson) control limits is calculated for the indicator. The control limits enable a banding of the indicator for comparison purposes.

Banding

Any relative risk of mortality is not a quantitative benchmarking measure. It is not intended to give exact mortality rates for a procedure, it is designed to highlight and show where a trust's mortality rate is not in line with outcomes nationwide.

There are four bands:

Where the relative risk of mortality is higher than the upper control limit the assigned band is red, "More than expected"
Where the relative risk of mortality is below the lower control limit the assigned band is green, "Less than expected"
Where the relative risk of mortality falls between the upper and lower control limits the assigned band is blue, "As expected"
If the expected figure is less than 1, it is likely that the sample size is too small to allow any meaningful comparison and the assigned band is black, "Sample too small"

Note: Where the expected figure lies between 1 and 5, the banding is restricted to red, "More than expected", and blue, "As expected".

Mortality rate: Knee replacement

Metric

Numerator

The total number of observed mortalities (in-hospital 30 days, 0-30 days inclusive) resulting from every finished inpatient spell at an acute trust for an elective Knee replacement procedure (the numerator is multiplied by 100).

The mortality must occur within 30 days of the date of the main procedure in the spell.

Denominator

The expected number of mortalities resulting from every finished inpatient spell at an acute trust for an elective knee replacement.

Data Source

Commissioning Data Sets (CDS)

Time frame

April 2006 - March 2009

Basis

Acute Trust

Statistical methods used

Banding

There are four bands:

Where the relative risk of mortality is higher than the upper control limit the assigned band is red, "More than expected"
Where the relative risk of mortality is below the lower control limit the assigned band is green, "Less than expected"
Where the relative risk of mortality falls between the upper and lower control limits the assigned band is blue, "As expected"
If the expected figure is less than 1, it is likely that the sample size is too small to allow any meaningful comparison and the assigned band is black, "Sample too small"

Note: Where the expected figure lies between 1 and 5, the banding is restricted to red, "More than expected", and blue, "As expected".

Mortality rate: Abdominal Aortic Aneurysm (AAA) repair

Metric

Numerator

The total number of observed mortalities (in-hospital 30 days, 0-30 days inclusive) resulting from every finished inpatient spell at an acute trust for an elective Abdominal Aortic Aneurysm (AAA) repair (the numerator is multiplied by 100).

The mortality must occur within 30 days of the date of the main procedure in the spell.

Denominator

The expected number of mortalities resulting from every finished inpatient spell at an acute trust for an elective Abdominal Aortic Aneurysm (AAA) repair.

Data Source

Commissioning Data Sets (CDS)

Time frame

April 2006 - March 2009

Basis

Acute Trust

Statistical methods used

Banding

There are four bands:

Where the relative risk of mortality is higher than the upper control limit the assigned band is red, "More than expected"
Where the relative risk of mortality is below the lower control limit the assigned band is green, "Less than expected"
Where the relative risk of mortality falls between the upper and lower control limits the assigned band is blue, "As expected"
If the expected figure is less than 1, it is likely that the sample size is too small to allow any meaningful comparison and the assigned band is black, "Sample too small"

Note: Where the expected figure lies between 1 and 5, the banding is restricted to red, "More than expected", and blue, "As expected".

If the expected figure lies between 1 and 5, the banding is restricted to Bands 1 and 2. When the expected figure is greater than five, Bands 1, 2 and 3 pertain.

MRSA rates

Metric

This indicator shows the rate of blood infections caused by MRSA for all patients. This includes those who are admitted as an emergency and those who are elective patients i.e. they have planned their treatment in advance. The data is presented as the number of cases per 10,000 bed days. A bed day is defined as one person in hospital for one night.

You can find out more information by visiting the Health Protection Agency website.

Data Source

The Health Protection Agency

Time frame

Financial year 2008/2009

Basis

Trust level information

Clostridium difficile infection rates

Metric

This indicator shows the rate of clostridium difficile infections for all patients. This includes those who are admitted as an emergency and those who are elective patients i.e. they have planned their treatment in advance. The data is presented as the number of cases per 1,000 bed days. A bed day is defined as one person in hospital for one night.

You can find out more information by visiting the Health Protection Agency website.

Data Source

The Health Protection Agency

Time frame

Financial year 2008/2009

Basis

Trust level information

Accident and Emergency Scorecard Indicators

Fracture of neck of femur - Operated on within two days

Metric

Percentage of operations performed within 2 days of admission for diagnosis of fractured neck of femur.

Numerator

Spells where opdate minus admission date less than 2

Denominator

All spells with primary diagnosis of fractured neck of femur where opdate is not null

ICD10 codes

S720-S722 Fracture of neck of femur (hip)

Exclude cases

Opdate is null

Data Source

SUS - CDS

Time frame

April 2008 - March 2009

Basis

Acute Trust

Statistical methods used

Crude rate

Thrombolytic treatment within 30 minutes of arrival at hospital

Metric

This indicator shows the percentage of eligible heart attack patients who received thrombolytic treatment within 30 minutes of arriving at the hospital.

The National Service Framework (NSF) for coronary heart disease (CHD) sets a standard that 75% of eligible heart attack patients in England should receive thrombolytic drugs within 30 minutes of arriving at hospital.

You can find out more information about the Myocardial Ischaemia National Audit Project by visiting the Royal College of Physicians website

Data Source

Myocardial Ischaemia National Audit Project 2008

Time frame

April 2008 - March 2009

Basis

Hospital Level

Thrombolytic treatment within 60 minutes of calling for professional help

Metric

This indicator shows the percentage of patients eligible heart attack patients who received thrombolytic treatment within 60 minutes of calling for professional help.

The call for professional help will usually be direct to the ambulance service but may be to a GP or NHS Direct.

The Department of Health has set NHS organisations in England the target of 68% of patients receiving thrombolytic treatment within 60 minutes of calling for professional help.

You can find out more information about the Myocardial Ischaemia National Audit Project by visiting the Royal College of Physicians website.

Data Source

Myocardial Ischaemia National Audit Project 2008

Time frame

April 2008 - March 2009

Basis

Hospital Level

Primary angioplasty within 90 minutes of arrival at interventional centre door

Metric

This indicator shows the percentage of patients that received primary angioplasty within 90 minutes of arrival at the interventional centre.

An interim good practice standard of 90 minutes from arrival at an interventional hospital to the time when the blocked artery is reopened (door to balloon time) has been agreed for provision of primary angioplasty, based on international guidelines.

You can find out more information about the Myocardial Ischaemia National Audit Project by visiting the Royal College of Physicians website.

Data Source

Myocardial Ischaemia National Audit Project 2008

Time frame

April 2008 - March 2009

Basis

Hospital Level

Patients discharged from hospital on secondary prevention medication

Metric

Recent national guidelines recommend that all patients who have had an acute heart attack should be offered treatment with a combination of the following drugs provided each drug is tolerated by the patient, and that the patient has no medical reason to avoid the drug:

ACE inhibitors/or angiotensin receptor blockers
aspirin
beta blockers
clopidogrel
statins

You can find out more information about the Myocardial Ischaemia National Audit Project by visiting the Royal College of Physicians website.

Data Source

Myocardial Ischaemia National Audit Project 2008

Time frame

April 2008 - March 2009

Basis

Hospital Level

NHS Trust homepage Indicators

Financial Management

Metric

This score looks at how well the organisation manages its finances. The Healthcare Commission assess all NHS trusts, including foundation trusts, in order to provide a rounded evaluation of their financial performance. This work draws heavily on assessments by other regulators, to reduce duplication and lessen the burden on trusts.

You can find out more information by visiting the Care Quality Commission website.

Data Source

Care Quality Commission Annual Health Check

Time frame

April 2008 - March 2009

Basis

Trust level information

Banding

Excellent - This score means that a trust received the highest score of either 'fully met' or 'excellent' for all applicable assessments that contribute to the overall quality of services score.

Good - This score means that a trust received at least the second highest score of either 'almost met' or 'good' for all applicable assessments that contribute to the overall quality of services score.

Fair - This score means that a trust has performed adequately, in that it has not received the lowest score of 'not met' for either core standards or existing national targets. However, it has not performed sufficiently well across the applicable assessments that contribute to the overall quality of services score to score any higher.

Weak - This score means that a trust received the lowest score of 'not met' for either core standards or existing national targets.

Overall Quality

Metric

This score covers a range of areas including safety of patients, cleanliness and waiting times.

You can find out more information by visiting the Healthcare Commission website.

Data Source

Care Quality Commission Annual Health Check

Time frame

April 2008 - March 2009

Basis

Trust level information

Banding

Excellent - This score means that a trust received the highest score of either 'fully met' or 'excellent' for all applicable assessments that contribute to the overall quality of services score.

Weak - This score means that a trust received the lowest score of 'not met' for either core standards or existing national targets.

18 week referral to treatment waits

Metric

This indicator shows information about the length of time patients have waited from referral by their GP to the date when the patient was admitted to hospital to begin their treatment. The information is presented by specialty (hospital departments).

The figure is calculated by comparing the total number of pathways completed within 18 weeks in the previous three months to the total number of completed pathways, with a known clock start, recorded on the RTT in the previous three months.

You can find out more information by visiting the Department of Health website.

Data Source

The Department of Health

Time frame

This information is updated monthly

Basis

Trust level information

Dignity and respect

Metric

Healthcare organisations have systems in place to ensure that:

staff treat patients, their relatives and carers with dignity and respect

You can find out more information by visiting the Care Quality Commission website.

Data Source

Care Quality Commission Annual Health Check

Time frame

April 2008 - March 2009

Basis

Trust level information

Banding

Compliant - This trust has assurance that it was compliant against this standard during the assessment year, without any significant lapses.

Insufficient assurance - The trust has insufficient assurance to fully determine whether it is compliant against this standard during the assessment year.

Not met - The trust declared there had been one or more significant lapses during the assessment year and as such they had not met this standard.

Infection control

Metric

Healthcare organisations keep patients, staff and visitors safe by having systems to ensure that:

the risk of healthcare acquired infection to patients is reduced with particular emphasis on high standards of hygiene and cleanliness, achieving year on year reductions in MRSA

You can find out more information by visiting the Care Quality Commission website.

Data Source

Care Quality Commission Annual Health Check

Time frame

April 2008 - March 2009

Basis

Trust level information

Banding

Compliant - This trust has assurance that it was compliant against this standard during the assessment year, without any significant lapses.

Insufficient assurance - The trust has insufficient assurance to fully determine whether it is compliant against this standard during the assessment year.

Not met - The trust declared there had been one or more significant lapses during the assessment year and as such they had not met this standard.

Incidents - reporting and learning

Metric

Healthcare organisations protect patients through systems that:

identify and learn from all patient safety incidents and other reportable incidents, and make improvements in practice based on local and national experience and information derived from the analysis of incidents

You can find out more information by visiting the Care Quality Commission website.

Data Source

Care Quality Commission Annual Health Check

Time frame

April 2008 - March 2009

Basis

Trust level information

Banding

Compliant - This trust has assurance that it was compliant against this standard during the assessment year, without any significant lapses.

Insufficient assurance - The trust has insufficient assurance to fully determine whether it is compliant against this standard during the assessment year.

Not met - The trust declared there had been one or more significant lapses during the assessment year and as such they had not met this standard.

Food provision & food needs

Metric

Where food is provided healthcare organisations have systems in place to ensure that:

patients are provided with a choice and that it is prepared safely and provides a balanced diet
patients' individual nutritional, personal and clinical requirements are met, including where necessary help with feeding and access

You can find out more information by visiting the Care Quality Commission website.

Data Source

Care Quality Commission Annual Health Check

Time frame

April 2008 - March 2009

Basis

Trust level information

Banding

Compliant - This trust has assurance that it was compliant against this standard during the assessment year, without any significant lapses.

Insufficient assurance - The trust has insufficient assurance to fully determine whether it is compliant against this standard during the assessment year.

Not met - The trust declared there had been one or more significant lapses during the assessment year and as such they had not met this standard.

Maintain the four hour maximum wait in A&E from arrival to admission, transfer or discharge

Metric

How many patients who attend Accident and Emergency department are seen and treated within 4 hours of arrival.

You can find out more information by visiting the Care Quality Commission website.

Data Source

Care Quality Commission Annual Health Check

Time frame

April 2008 - March 2009

Basis

Trust level information

Banding

Achieved - This organisation performed to a high level for the indicator(s) underpinning this target.

Underachieved - The performance of this organisation was below the required level for the indicator(s) underpinning this target. This score may have been given because this organisation scored 'data not returned' for the indicator(s).

Failed - The performance of this organisation was poor for the indicator(s) underpinning this target. This score may have been given because this organisation scored 'data not returned' for the indicator(s).

Not applicable - This indicator or target did not apply to this organisation. As a result, this organisation was not assessed against it.

Data not available - This indicator or target did apply to this organisation, but the relevant data was not available. This was not the fault of the organisation, so it was not assessed against this indicator or target.

Doctors per 100 beds

Metric

Dr Foster Research has calculated the ratio of doctors to 100 beds at each NHS Trust or board. This ratio has been shown to have a strong link to mortality figures: hospitals with high doctors per bed tend to have better than expected mortality ratios, and vice versa.

Data Source

England - Staffing figures are whole time equivalent and published in the Department of Health NHS Hospital, Public Health Medicine and Community Health Service - Medical and Dental Workforce Census, England: 30 September 2008.

The number of beds at each hospital is published in the 'Bed availability and occupancy, England - KH03' return and is for the financial year 2007/08.

Northern Ireland - Staffing figures are whole time equivalent and published in the Northern Ireland Health and Social Care Workforce Census: 31 March 2008.

The number of beds at each hospital is published in the Department of Health, Social Services and Public Safety Volume 2a: Inpatient Specialty Tables and is for the financial year 2007/08.

Scotland - Staffing figures are whole time equivalent and published in the NHS Scotland, Medical and Dental Staff in post 2008.

The number of beds at each hospital is published in the NHS Scotland Available Beds by Specialty & NHS Board of Treatment and is for the financial year 2007/08.

Wales - Staffing figures are whole time equivalent and published in the StatsWales Hospital Medical and Dental staff by organisation 2008.

The number of beds at each hospital is published in the StatsWales NHS Beds by NHS Region and Trust and is for the financial year 2007/08.

Time frame

England: April 2008 - March 2009

NI, Scotland, Wales: April 2007 - March 2008

Basis

Trust level

Nurses per 100 beds

Metric

Dr Foster Research has calculated the ratio of nurses per 100 beds at each NHS Trust or board.

Data Source

England - Nurse numbers are whole time equivalent and published in the Department of Health NHS Hospital, Public Health Medicine and Community Health Service Non-medical Workforce Census, England: 30 September 2008. Qualified nurses in the following grades are used for the staff-bed ratio calculation: Qualified nursing, midwifery & health visiting staff.

The number of beds at each hospital is published in the 'Bed availability and occupancy, England - KH03' return and is for the financial year 2007/08.

Northern Ireland - Staffing figures are whole time equivalent and published in the Northern Ireland Health and Social Care Workforce Census: 31 March 2008.

The number of beds at each hospital is published in the Department of Health, Social Services and Public Safety Volume 2a: Inpatient Specialty Tables and is for the financial year 2007/08.

Scotland - Staffing figures are whole time equivalent and published in the NHS Scotland, Nursing and midwifery in post 2008.

The number of beds at each hospital is published in the NHS Scotland Available Beds by Specialty & NHS Board of Treatment and is for the financial year 2007/08.

Wales - Staffing figures are whole time equivalent and published in the StatsWales Nursing, midwifery and HV staff by organisation.

The number of beds at each hospital is published in the StatsWales NHS Beds by NHS Region and Trust and is for the financial year 2007/08.

Time frame

England: April 2008 - March 2009

NI, Scotland, Wales: April 2007 - March 2008

Basis

Trust level

Hospital homepages

General hospital information

Metric

Information about the facilities available at individual hospitals has been drawn from the Hospital Estates and Facilities Statistics data-set. The fields used include:

number of beds
percentage of single rooms
total parking spaces available for patients/visitors
average parking fee per hour

More information can be found on the Hospital Estates and Facilities Statistics website.

Data Source

The Information Centre - Hospital Estates and Facilities Statistics

Time frame

April 2008 - March 2009

Basis

Hospital Level