Data consistency in the English Hospital Episodes Statistics database

Hospital length of stay, 30-day emergency readmissions and the role of the DrEaMing enhanced recovery pathways in colonic and rectal surgery in England

BACKGROUND

Enhanced recovery pathways (ERPs) are designed to improve patient outcomes after elective surgery. Our primary aim was to examine whether shorter hospital stay, as a surrogate ERP outcome, was associated with higher 30-day emergency readmission rates for colonic and rectal surgery in England. A secondary aim was to assess how hospital trust compliance with a specific postoperative care bundle, drinking, eating, and mobilising (DrEaMing) within 24 h, relates to outcomes.

METHODS

This was a retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged ≥17 yr undergoing elective colonic or rectal surgery for cancer between April 1, 2014, and March 31, 2024, were included.

RESULTS

Shorter hospital stays were significantly associated with a lower rate of 30-day emergency readmission among 124 580 colonic and 87 036 rectal surgery patients. Comparing the first (reference) and fourth quartile of length of stay, the odds of 30-day emergency readmission increased by 2.16 (95% confidence interval [CI] 2.04-2.30) and 2.41 (95% CI 2.26-2.57) for colonic and rectal surgery, respectively. Increased hospital trust DrEaMing compliance was associated with a reduction in the number of patients with extended length of stay (colonic surgery: X2=24.885, P<0.001; rectal surgery: X2=61.670, P<0.001) and was not associated with 30-day emergency readmission.

CONCLUSIONS

We found no evidence that shorter length of stay, or greater DrEaMing compliance, were associated with higher emergency admission rates. These findings should not be interpreted as causal.

What is the impact of longer patient travel distances and times on perioperative outcomes following revision knee replacement: a retrospective observational study using data for England from Hospital Episode Statistics

OBJECTIVES

Patients undergoing revision total knee replacement (RevKR) surgery often have difficulties mobilising and increasingly rely on family support. Evolving practice in England aims to manage these patients in specialised centres with the intention of improving outcomes. This practice will result in longer travel distances and times in this frailer group of patients. We want to examine the types of distances and travel times patients can be expected to travel for this complex orthopaedic surgery and to explore concerns of how these impact patient outcomes.

DESIGN

Retrospective observational study from the Hospital Episode Statistics. Multivariable adjusted logistic regression models were used to investigate the relationship between patient travel distances and times with perioperative outcomes.

SETTING

Patients presenting to tertiary referral centres between 1 January 2016 and 31 December 2019. A tertiary referral centre was defined as a trust performing >49 revisions in the year prior.

PARTICIPANTS

Adult patients undergoing RevKR procedures for any reason between 1 January 2016 ando 31 December 2019.

EXPOSURE

The shortest patient level travel distance and time was calculated using the Department of Health Journey Time Statistics using Transport Accessibility and Connectivity Calculator software and Dijkstra's algorithm.

MAIN OUTCOME MEASURES

The primary outcome is emergency readmission within 30 days. Secondary outcomes are mortality within 90 days and length of inpatient stay.

RESULTS

6880 patients underwent RevKR at 36 tertiary referral centres. There was a weak correlation between social deprivation and travel distance, with patients from the most deprived areas travelling longer distances. Overall, 30-day readmission was not statistically associated with longer driving distance (OR 1.00 95% CI 0.99 to 1.02) or peak driving times (OR 1.00 95% CI 0.99 to 1.01).

CONCLUSIONS

There was no association between increasing travel distance and time on perioperative outcomes for RevKR patients.

Trends Over Time in the Use, Carbon Footprint and Costs of Facet Joint Injections and Medial Branch Blocks to Manage Lumbar Pain in England: Retrospective Analysis of an Administrative Dataset

STUDY DESIGN

Retrospective analysis of an administrative dataset.

OBJECTIVE

This study aims to investigate changing practice over a six-year period in the use of repeated lumbar facet joint injections/medial branch blocks in England.

METHODS

Patient data were extracted from the Hospital Episodes Statistics database for the period 1st April 2015 to 31st March 2021 for the index lumbar injection and for repeat lumbar injections performed within one year of the first. The exposure of interest was two injections within 180 days or three within one year. Patients aged <17 years and where the body site was listed as cervical, thoracic or sacral were excluded.

RESULTS

Data were available for 134,249 patients of which, 8,922 (6.6%) had either two injections within 180 days or three injections within one year. First injections fell from 42,511 in 2015/16 to 13,368 in 2019/20 as did the number of repeat injections: 4,018 to 424 for the same period. If all years had the same carbon footprint as 2019/20, 2.8 kilotons of CO2e would have been saved over the five years, enough to power 2,575 average UK homes for 1 year. The financial cost of injections decreased from £27.6 million in 2015/16 to £7.9 million in 2019/20.

CONCLUSIONS

The number of patients having repeated lumbar injections has decreased over time but has not been eliminated. More work is needed to educate patients and clinicians regarding alternative and more effective treatments.

The volume-outcome relationship for endoscopic transsphenoidal pituitary surgery for benign neoplasm: analysis of an administrative dataset for England

BACKGROUND

Setting minimum annual volume thresholds for pituitary surgery in England is seen as one way of improving outcomes for patients and service efficiency. However, there are few recent studies from the UK on whether a volume-outcome effect exists, particularly in the era of endoscopic surgery. Such data are needed to allow evidence-based decision making. The aim of this study was to use administrative data to investigate volume-outcome effects for endoscopic transsphenoidal pituitary surgery in England.

METHODS

Data from the Hospital Episodes Statistics database for adult endoscopic transsphenoidal pituitary surgery for benign neoplasm conducted in England from April 2013 to March 2019 (inclusive) were extracted. Annual surgeon and trust volume was defined as the number of procedures conducted in the 12 months prior to the index procedure. Volume was categorised as < 10, 10-19, 20-29, 30-39 and ≥40 procedures for surgeon volume and < 20, 20-39, 40-59, 60-79 and ≥80 procedures for trust volume. The primary outcome was repeat ETSPS during the index procedure or during a hospital admission within one-year of discharge from the index procedure.

RESULTS

Data were available for 4590 endoscopic transsphenoidal pituitary procedures. After adjustment for covariates, higher surgeon volume was significantly associated with reduced risk of repeat surgery within one year (odds ratio (OR) 0.991 (95% confidence interval (CI) 0.982-1.000)), post-procedural haemorrhage (OR 0.977 (95% CI 0.967-0.987)) and length of stay greater than the median (0.716 (0.597-0.859)). A higher trust volume was associated with reduced risk of post-procedural haemorrhage (OR 0.992 (95% CI 0.985-0.999)), but with none of the other patient outcomes studied.

CONCLUSIONS

A surgeon volume-outcome relationship exists for endoscopic transsphenoidal pituitary surgery in England.

Estimated Carbon Savings from Changing Surgical Trends in Primary Elective Total Hip Arthroplasty in England: A Retrospective Observational Study

BACKGROUND

The National Health Service (NHS) in England has set a target to be net zero for carbon emissions by 2045. The aim of this study was to investigate how changes in key aspects of clinical practice over the last 8 years have contributed towards reducing the per-patient carbon footprint of elective total hip arthroplasty (THA).

METHODS

This was a retrospective analysis of administrative data. Data were extracted from the Hospital Episode Statistics database for all adult (≥ 17 years), primary, elective THA procedures conducted in England from 1 April, 2014 to 31 March, 2022. The estimated carbon footprint for key elements of the surgical pathway were calculated based on data from Greener NHS and the Sustainable Healthcare Coalition.

RESULTS

Data were available for 537,441 THA procedures conducted during the study period. The per-patient carbon footprint associated with the primary THA (index) procedure fell by around 25% from 2014/15 to 2021/22. Length of stay was by far the largest contributor to this decline, falling from 169.1 kgCO2e to 117.6 kgCO2e per patient from 2014/15 to 2021/22. Absolute declines in the carbon footprint associated with emergency readmissions, revisions and outpatient attendances were more modest. If all patients in all years had the 2021/22 average carbon footprint, then carbon equivalent to powering 19,976 UK homes for 1 year would have been saved.

CONCLUSIONS

Improving per-patient efficiency of surgery is likely to contribute towards meeting the NHS's net-zero target whilst also helping to improve patient outcomes, reduce costs and cut waiting lists.

Association of day-case rates with post COVID-19 recovery of elective laparoscopic cholecystectomy activity across England

INTRODUCTION

The aim of this study was to investigate the safety of day-case laparoscopic cholecystectomy, and the association between day-case rates and, post the COVID-19 pandemic, recovery of activity to prepandemic levels for integrated care boards (ICBs) in England.

METHODS

This was a retrospective observational study of the Hospital Episodes Statistics (HES) data set. Elective laparoscopic cholecystectomies for the period 1 January 2019 to 31 December 2022 were identified. Activity levels for 2022 were compared with those for the whole of 2019 (baseline). Day-case activity was identified where the length of stay recorded in the HES was zero days.

RESULTS

Data were available for 184,252 patients across the 42 ICBs in England, of which 120,408 (65.3%) were day-case procedures. By December 2022, activity levels for the whole of England had returned to 88.2% of prepandemic levels. The South West region stood out as having recovered activity levels to the greatest extent, with activity at 97.3% of prepandemic levels during 2022. The South West also had the highest postpandemic day-case rate at 74.9% of all patients seen as a day-case during 2022; this compares with an England average of 65.3%. At an ICB level, there was a significant correlation between day-case rates and postpandemic activity levels (r = 0.362, p = 0.019). There was no strong or consistent evidence that day-case surgery had poorer patient outcomes than inpatient surgery.

CONCLUSIONS

Recovery of elective laparoscopic cholecystectomy activity has been better in South West England than in other regions. Increasing day-case rates may be important if ICBs in other regions are to increase activity levels up to and beyond prepandemic levels.

The carbon footprint of cataract surgery pathways in England: an observational study using administrative data

BACKGROUND

The National Health Service (NHS) in England has set a target to be net zero for carbon emissions by 2045. The aim of this study was to investigate the estimated difference between the carbon footprint of the Getting It Right First Time (GIRFT) High Volume Low Complexity (HVLC) pathway for cataract surgery and current practice.

METHODS

Retrospective analysis of administrative data. Data were extracted from the Hospital Episode Statistics database for all elective cataract surgery procedures conducted in England from 1st April 2021 to 31st March 2022.

RESULTS

The England average carbon footprint was 100.0 kgCO2e (ranging from 74.8 kgCO2e - 128.0 kgCO2e depending on Integrated Care Board). Had all Integrated Care Boards adhered to the GIRFT HVLC pathway, then 17.5 kilotonsCO2e would have been saved in 2021-22. The main limitation of our study is that only key elements of the cataract surgery pathway were included in the analysis.

CONCLUSIONS

Even in a standardised healthcare pathway such as cataract surgery and within a publicly funded national healthcare system, significant differences in practice exist. With this paper we have demonstrated that tackling this unwarranted variation and adhering to the GIRFT HVLC pathway where possible has the potential to reduce the carbon footprint of cataract surgery.

Carbon savings associated with changing surgical trends in total knee arthroplasty in England: a retrospective observational study using administrative data

BACKGROUND

Best practice pathways for common surgical procedures, including total knee arthroplasty (TKA), have the potential to improve patient outcomes and reduce carbon emissions. We aimed to estimate the reduction in carbon emissions due to changing trends in the care of patients undergoing TKA in England.

METHODS

This was a retrospective analysis of Hospital Episode Statistics data from 1 April 2013 to 31 March 2022 on adults undergoing elective primary TKA in England. The carbon footprint for each patient was calculated using carbon factors for multiple steps in the pathway, including ipsilateral knee arthroscopies in the year preceding the TKA, outpatient attendances, the index TKA, revisions of the TKA performed within 180 days of the index procedure, length of hospital stay and emergency readmissions.

RESULTS

A total of 648,861 TKA operations were identified. Over the study period, the median length of stay reduced from four to three days, the proportion of patients undergoing ipsilateral knee arthroscopies performed within a year before TKA surgery fell from 5.9% to 0.5% and the number of early revisions and emergency readmissions also fell. The per-patient carbon footprint reduced from 378.8kgCO2e to 295.2kgCO2e over this time. If all the study patients had the same carbon footprint as the average patient in 2021/2022, 32.4kilotons CO2e would have been saved, enough to power 29,509 UK homes for one year.

CONCLUSIONS

Practices that were introduced primarily to improve patient outcomes can contribute to a reduction in the carbon footprint.

Potential application of artificial intelligence in cancer therapy

PURPOSE OF REVIEW

This review underscores the critical role and challenges associated with the widespread adoption of artificial intelligence in cancer care to enhance disease management, streamline clinical processes, optimize data retrieval of health information, and generate and synthesize evidence.

RECENT FINDINGS

Advancements in artificial intelligence models and the development of digital biomarkers and diagnostics are applicable across the cancer continuum from early detection to survivorship care. Additionally, generative artificial intelligence has promised to streamline clinical documentation and patient communications, generate structured data for clinical trial matching, automate cancer registries, and facilitate advanced clinical decision support. Widespread adoption of artificial intelligence has been slow because of concerns about data diversity and data shift, model reliability and algorithm bias, legal oversight, and high information technology and infrastructure costs.

SUMMARY

Artificial intelligence models have significant potential to transform cancer care. Efforts are underway to deploy artificial intelligence models in the cancer practice, evaluate their clinical impact, and enhance their fairness and explainability. Standardized guidelines for the ethical integration of artificial intelligence models in cancer care pathways and clinical operations are needed. Clear governance and oversight will be necessary to gain trust in artificial intelligence-assisted cancer care by clinicians, scientists, and patients.

Factors associated with conversion from day-case to in-patient elective inguinal hernia repair surgery across England: an observational study using administrative data

PURPOSE

Elective primary inguinal hernia repair surgery is increasingly being conducted as a day-case procedure. However, some patients planned for day-case surgery have to stay in hospital for at least one night. The aim of this study was to identify the factors associated with conversion from day-case to in-patient management for elective inguinal hernia repair surgery.

METHODS

This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged ≥ 17 years undergoing a first elective inguinal hernia repair between 1st April 2014 and 31st March 2022 that was planned as day-case surgery were identified. The exposure of interest was discharged on the day of admission (day-case) or requiring overnight stay. The primary outcome of interest was 30-day emergency readmission with an overnight stay. For reporting, providers were aggregated to an Integrated Care Board (ICB) level.

RESULTS

A total of 351,528 planned day-case elective primary inguinal hernia repairs were identified over the eight-year study period. Of these, 45,305 (12.9%) stayed in hospital for at least one night and were classed as day-case to in-patient stay conversions. Patients who converted to in-patient stay were older, had more comorbidities, and were more likely to have bilateral surgery and be operated on by a low-annual volume surgeon. Post-procedural complications were strongly associated with conversion. Across the 42 ICBs in England, model-adjusted conversion rates varied from 3.3% to 21.3%.

CONCLUSIONS

There was considerable variation in conversion to in-patient stay rates for inguinal hernia repair across ICBs in England. Our findings should help surgical teams to better identify patients suitable for day-case inguinal hernia repair and plan discharge services more effectively. This should help to reduce the variation in conversion rates.

Foresight-a generative pretrained transformer for modelling of patient timelines using electronic health records: a retrospective modelling study

BACKGROUND

An electronic health record (EHR) holds detailed longitudinal information about a patient's health status and general clinical history, a large portion of which is stored as unstructured, free text. Existing approaches to model a patient's trajectory focus mostly on structured data and a subset of single-domain outcomes. This study aims to evaluate the effectiveness of Foresight, a generative transformer in temporal modelling of patient data, integrating both free text and structured formats, to predict a diverse array of future medical outcomes, such as disorders, substances (eg, to do with medicines, allergies, or poisonings), procedures, and findings (eg, relating to observations, judgements, or assessments).

METHODS

Foresight is a novel transformer-based pipeline that uses named entity recognition and linking tools to convert EHR document text into structured, coded concepts, followed by providing probabilistic forecasts for future medical events, such as disorders, substances, procedures, and findings. The Foresight pipeline has four main components: (1) CogStack (data retrieval and preprocessing); (2) the Medical Concept Annotation Toolkit (structuring of the free-text information from EHRs); (3) Foresight Core (deep-learning model for biomedical concept modelling); and (4) the Foresight web application. We processed the entire free-text portion from three different hospital datasets (King's College Hospital [KCH], South London and Maudsley [SLaM], and the US Medical Information Mart for Intensive Care III [MIMIC-III]), resulting in information from 811 336 patients and covering both physical and mental health institutions. We measured the performance of models using custom metrics derived from precision and recall.

FINDINGS

Foresight achieved a precision@10 (ie, of 10 forecasted candidates, at least one is correct) of 0·68 (SD 0·0027) for the KCH dataset, 0·76 (0·0032) for the SLaM dataset, and 0·88 (0·0018) for the MIMIC-III dataset, for forecasting the next new disorder in a patient timeline. Foresight also achieved a precision@10 value of 0·80 (0·0013) for the KCH dataset, 0·81 (0·0026) for the SLaM dataset, and 0·91 (0·0011) for the MIMIC-III dataset, for forecasting the next new biomedical concept. In addition, Foresight was validated on 34 synthetic patient timelines by five clinicians and achieved a relevancy of 33 (97% [95% CI 91-100]) of 34 for the top forecasted candidate disorder. As a generative model, Foresight can forecast follow-on biomedical concepts for as many steps as required.

INTERPRETATION

Foresight is a general-purpose model for biomedical concept modelling that can be used for real-world risk forecasting, virtual trials, and clinical research to study the progression of disorders, to simulate interventions and counterfactuals, and for educational purposes.

FUNDING

National Health Service Artificial Intelligence Laboratory, National Institute for Health and Care Research Biomedical Research Centre, and Health Data Research UK.

Factors associated with poorer outcomes for posterior lumbar decompression and or/or discectomy: an exploratory analysis of administrative data

PURPOSE

This study aimed to identify factors associated with poorer patient outcomes for lumbar decompression and/or discectomy (PLDD).

METHODS

We extracted data from the Hospital Episodes Statistics database for the 5 years from 1st April 2014 to 31st March 2019. Patients undergoing an elective one- or two-level PLDD aged ≥ 17 years and without evidence of revision surgery during the index stay were included. The primary patient outcome measure was readmission within 90 days post-discharge.

RESULTS

Data for 93,813 PLDDs across 111 hospital trusts were analysed. For the primary outcome, greater age [< 40 years vs 70-79 years odds ratio (OR) 1.28 (95% confidence interval (CI) 1.14 to 1.42), < 40 years vs ≥ 80 years OR 2.01 (95% CI 1.76-2.30)], female sex [OR 1.09 (95% CI 1.02-1.16)], surgery over two spinal levels [OR 1.16 (95% CI 1.06-1.26)] and the comorbidities chronic pulmonary disease, connective tissue disease, liver disease, diabetes, hemi/paraplegia, renal disease and cancer were all associated with emergency readmission within 90 days. Other outcomes studied had a similar pattern of associations.

CONCLUSIONS

A high-throughput PLDD pathway will not be suitable for all patients. Extra care should be taken for patients aged ≥ 70 years, females, patients undergoing surgery over two spinal levels and those with specific comorbidities or generalised frailty.

Day-case and in-patient elective inguinal hernia repair surgery across England: an observational study of variation and outcomes

PURPOSE

Elective primary inguinal hernia repair surgery is increasingly being conducted as a day-case procedure. However, in England there is evidence of wide variation in day-case rates across hospitals. Reducing the extent of this variation has the potential to support more efficient use of resources (e.g., clinician time, hospital beds) and help the recovery of elective surgical activity following the COVID-19 pandemic. The aims of this study were to explore the extent of variation in day-case rates across healthcare providers in England and to evaluate the safety of day-case elective primary inguinal hernia repair surgery.

METHODS

This was an exploratory, retrospective analysis of observational data from the Hospital Episode Statistics data set for England. All patients aged ≥ 17 years undergoing a first elective inguinal hernia repair between 1st April 2014 and 31st March 2022 were identified. The exposure of interest was day-case or in-patient stay, and the primary outcome of interest was 30-day emergency readmission with an overnight stay. For reporting, providers were aggregated to an Integrated Care Board (ICB) level.

RESULTS

A total of 413,059 elective primary inguinal hernia repairs were identified over the 8-year study period. Of these, 326,833 (79.1%) were day-case procedures. During the most recent financial year (2021-22), the highest day-case rate for an ICB was 93.8% and the lowest 66.1%. After adjusting for covariates, day-case surgery was associated with significantly lower rates of 30-day emergency readmission (odds ratio (OR) 0.61, 95% confidence interval (CI) 0.58-0.64, p < 0.001) and for the secondary outcomes 180-day mortality and haemorrhage, infection and pain at 30-day post-discharge. Rates of 30-day emergency readmission were significantly lower in ICBs with high rates of day-case surgery (OR 0.84, 95% CI 0.74-0.96, p < 0.001) than in ICBs with low rates of day-case surgery, although rates of post-procedural haemorrhage within 30 days of discharge were significantly higher in trusts with high day-case rates (OR 1.20, 95% CI 1.04-1.40, p = 0.015).

CONCLUSIONS

For the outcomes studied, we found no consistent evidence that day-case elective inguinal hernia repair was unsafe for selected patients. Currently, there is substantial variation between ICBs in terms of delivering day-case surgery. Reducing this variability may help address the current pressures on the NHS in elective surgery.

Paediatric hospitalisation related to medications administration errors of non-opioid analgesics, antipyretics and antirheumatics in England and Wales: a longitudinal ecological study

OBJECTIVE

This study aimed to explore paediatric hospitalisation related to medication administration errors (MAEs) of non-opioid analgesics, antipyretics and antirheumatics in England and Wales.

DESIGN

An ecological study.

SETTING

A population-based study on hospitalised patients in England and Wales. Hospital admission data were extracted from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales for the period between April 1999 and April 2020. Admissions cause was confirmed using the diagnostic codes T39.0-T39.9.

PARTICIPANTS

Paediatric patients aged 15 years and below who were hospitalised at all National Health Service (NHS) trusts and any independent sector funded by NHS trusts.

PRIMARY OUTCOME MEASURE

Hospitalisation rates related to MAEs of non-opioid analgesics, antipyretics and antirheumatics.

RESULTS

The yearly number of admissions for MAEs associated with non-opioid analgesics, antipyretics and antirheumatics experienced a notable growth of 21.7% over the span of two decades, rising from 4574 cases in 1999 to 5568 cases in 2020. The observed increase demonstrates a significant upward trend in hospital admissions rate, with a 12.3% growth from 46.16 per 100 000 individuals in 1999 to 51.83 per 100 000 individuals in 2020 (95% CIs 44.83 to 47.50 and 50.47 to53.19, respectively, trend test, p<0.05). The therapeutic categories that exhibited the highest frequency of MAEs were '4-aminophenol derivatives' and 'other non-steroidal anti-inflammatory drugs', accounting for 79.3% and 16.0% of cases, respectively. It is worth noting that there was a significant increase of 28.9% in hospitalisations linked to MAEs specifically associated with '4-aminophenol derivatives.'

CONCLUSION

The research revealed a notable rise in the overall yearly number of hospital admissions associated with MAEs within the paediatric population. This study emphasises the necessity for additional research aimed at mitigating the potential hazards associated with the ingestion of these medications, particularly within susceptible demographics, such as young children.

The association of demographics, frailty and multiple health conditions with outcomes from acute medical admissions to hospitals in England: exploratory analysis of an administrative dataset

Emergency and acute hospital services in England are under increasing pressure. The aim of this study was to investigate the association between key case-mix indicators and outcomes for adults admitted to hospital with an acute medical condition in England. All patients aged ≥16 years admitted to hospital in England as an acute unselected medical admission and who survived to discharge during the financial year 2021-2022 were included. Length of hospital stay was the primary outcome of interest. Data were available for 1,586,168 unique patients. A case-mix index was developed with a score that ranged from 0 to 12. Frailty was the most important variable in the index, followed by multiple health conditions and patient age. The mean case-mix score across hospital trusts in England ranged from 5.3 to 7.8. The case-mix index will support initiatives to better understand factors contributing to outcomes from acute medical admissions to hospital.

Comparing reported management of ureteric stones between clinical audit and administrative datasets: An opportunity to streamline clinical audit

OBJECTIVES

To compare recorded patient management between a clinical audit and administrative dataset for patients presenting with ureteric stones in England and to assess the feasibility of using administrative data for routine audit.

PATIENTS AND METHODS

The British Association of Urological Surgeons conducted a clinical audit of all patients presenting as an emergency to 107 hospitals in England during November 2020 with ureteric stones. All patients were followed up until 31st March 2021 and in-patient and out-patient management received recorded. These clinical audit data were compared to those available from the English Hospital Episode Statistics (HES) administrative database covering the same time period.

RESULTS

Data were available for 2344 patients from HES, and 2050 patients admitted to the same 107 hospitals from clinical audit. The two cohorts were well matched for age (mean 47.2 years and 49.3 years respectively), but with a higher proportion of females in the HES dataset (42.2 % vs 30.1 %). Recorded treatment received was similar in both cohorts, other than for ureteroscopy, which was significantly under recorded in HES, most obviously following initial stent placement (17.2 % vs 26.0 % ureteroscopy as final management respectively).

CONCLUSIONS

The two data sources were generally well matched in terms of patient numbers, age and management. The higher number of patients and females in HES may be due to initial misdiagnosis of abdominal pain as ureteric stones in females. The reasons for discrepancies in recording of ureteroscopy are unclear and warrant further investigation. Administrative data can complement clinical audit data and streamline the audit process, but issues around data quality should be studied prior to use of administrative data for this purpose.

Comparison of outcomes for patients with and without a serious mental illness presenting to hospital for chronic obstruction pulmonary disease: retrospective observational study using administrative data

BACKGROUND

There are few data on the profile of those with serious mental illness (SMI) admitted to hospital for physical health reasons.

AIMS

To compare outcomes for patients with and without an SMI admitted to hospital in England where the primary reason for admission was chronic obstructive pulmonary disease (COPD).

METHOD

This was a retrospective, observational analysis of the English Hospital Episodes Statistics data-set for the period from 1 April 2018 to 31 March 2019, for patients aged 18-74 years with COPD as the dominant reason for admission. Patient with an SMI (psychosis spectrum disorder, bipolar disorder) were identified.

RESULTS

Data were available for 54 578 patients, of whom 2096 (3.8%) had an SMI. Patients with an SMI were younger, more likely to be female and more likely to live in deprived areas than those without an SMI. The burden of comorbidity was similar between the two groups. After adjusting for covariates, SMI was associated with significantly greater risk of length of stay than the median (odds ratio 1.24, 95% CI 1.12-1.37, P ≤ 0.001) and with 30-day emergency readmission (odds ratio 1.51, 95% confidence interval 1.34-1.69, P ≤ 0.001) but not with in-hospital mortality.

CONCLUSION

Clinicians should be aware of the potential for poorer outcomes in patients with an SMI even when the SMI is not the primary reason for admission. Collaborative working across mental and physical healthcare provision may facilitate improved outcomes for people with SMI.