=
pb`Jnl=ofc=ïçêâëíêÉ~ãëW==ëÜçêí=ëí~ó=Üáé=êÉéä~ÅÉãÉåí=
eáé=oÉéä~ÅÉãÉåí=`çåëìäí~åí=qççä= XXXXXXXX Hospitals Trust Consultants Length of Stay Primary Hip Replacement (OPCS W371, W381, W391) Patients Discharged Dec 09 to Nov 10 12 ESHT uuuu= Consultants >=15 Ops
10
uuuu= ESHT Consultants <15 Ops Other Consultants National 09/10 Upper Quartile National 09/10 Median National 09/10 Mean
8
6
4
2
0
The short stay hip replacement programme commenced in 2004 when Mr Hugh Apthorp, an Orthopaedic Surgeon working at the Conquest Hospital in Hastings, developed a programme to significantly reduce the amount of time spent in hospital for patients undergoing a total hip replacement. Mr Apthorp currently has the lowest average length of stay nationally for this operation (2.7 days). Approximately 67% of his patients experience a maximum 2 day stay in hospital compared to 3% nationally. The care that his team provides is safe, provides high levels of patient acceptance and feedback and saves money. Mt Apthorp was successful in his bid to the Regional Innovation Fund in 2010. In order to assist in spreading best practice throughout Kent, Surrey and Sussex the Quality Observatory worked with Mr Apthorp to develop a tool enabling consultants to analyse and compare themselves against all others in the region. This leaflet provides an overview of the tool that has been developed.
Turn over to find out more…...
ïïïKnì~äáíólÄëÉêî~íçêóKåÜëKìâ=
tÜ~íÛë=áå=íÜÉ=eáé=qççä\= Data used in the hip tool is all sourced from SUS, in other words it uses the Trust’s own submitted data and is provided as an Excel spreadsheet. There are a number of elements to the tool allowing consultants and other key users to gain a quick overview of current practice at a Trust. Here we see the all consultants overview, this allows you to select an individual organisation and compare mean length of stay within the Trust and across the whole region by consultant for the most recent 12 month period. . XXXXXXXX Hospitals Trust Consultants
Consultants at the Trust with less than 15 procedures in the year are shown in a different colour to distinguish them.
Length of Stay Primary Hip Replacement (OPCS W371, W381, W391) Patients Discharged Dec 09 to Nov 10 12 ESHT uuuu= Consultants >=15 Ops uuuu= Consultants <15 Ops ESHT Other Consultants
10
National 09/10 Upper Quartile National 09/10 Median
In addition there is a drop down box which allows you to select which comparators to use— national, patch or trust top quartile and decile and whether to use the median or mean average.
National 09/10 Mean
8
6
The number of operations undertaken by each Consultant during the 12 month period is also clearly identified.
4
2
0
The next view provided by the toolkit provides summary information for all Consultants within the selected Trust. It details the following -
XXXXXXX Hospitals Trust Consultants 1ry Hip Repl (OPCS W371, W381, W391) Patients Discharged Dec 09 - Nov 10
•
Numbers of spells;
•
Bed days;
Consultant
Spells
Bed Days
Avg LoS
Preop LoS
Mortality
% Complications
30 Day Readmits
•
Average length of stay;
•
Preoperative length of stay;
•
In-hospital mortality;
•
Proportion of patients with a complication of surgical treatment diagnosis code in any part of their hospital spell;
•
30 day emergency readmissions at any Trust within South East Coast.
CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX CXXXXXXX
19 6 19 11 20 32 12 111 10 7 29 107 5 16 4
73 19 85 47 123 162 46 300 45 20 151 512 16 73 21
3.8 3.2 4.5 4.3 6.2 5.1 3.8 2.7 4.5 2.9 5.2 4.8 3.2 4.6 5.3
0.0 0.0 0.2 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.0 0.0 0.0
0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
0% 0% 0% 0% 10% 0% 0% 2% 10% 0% 7% 8% 0% 6% 0%
11% 0% 5% 0% 10% 6% 8% 5% 10% 0% 3% 7% 0% 6% 0%
Last 100 Primary Hip Replacement Patients Discharged for Consultant C0358909 Source: SUS Extracts, OPCS W371, W381, W391 on admitting episode
25
20
15
10
5
LoS
Median 4.5 Days
Mean
4.9 Days
31/07/10 24/09/10 01/10/10 15/10/10 01/11/10 13/11/10 19/11/10 26/11/10 28/11/10 11/12/10
23/12/06 02/02/07 14/02/07 14/03/07 31/03/07 13/04/07 18/04/07 04/05/07 05/06/07 24/06/07 20/07/07 30/07/07 17/08/07 29/08/07 31/08/07 29/09/07 16/10/07 29/10/07 15/11/07 15/12/07 22/12/07 16/02/08 03/03/08 08/03/08 16/03/08 18/03/08 15/04/08 24/04/08 16/07/08 21/07/08 31/07/08 25/10/08 15/11/08 15/12/08 18/01/09 30/03/09 16/04/09 21/04/09 25/04/09 16/05/09 07/07/09 09/07/09 13/07/09 28/08/09 05/10/09 16/10/09 09/11/09 05/12/09 11/01/10 12/02/10 13/02/10 22/02/10 15/03/10 10/05/10 04/06/10 11/06/10
14/03/06 28/03/06 11/04/06 15/04/06 03/06/06 05/08/06 15/08/06 06/09/06 08/09/06 09/10/06 20/10/06 30/10/06 27/11/06
06/08/05 09/08/05 05/09/05 10/10/05 18/10/05 08/11/05 22/11/05 01/12/05 21/12/05 04/01/06 12/01/06 17/01/06 23/01/06 30/01/06 07/02/06 06/03/06
0 11/07/05
Each bar in the chart represents the length of stay for an individual patient and is ordered from left to right in terms of date. Reference lines are included showing the median, mean and Upper Confidence Limit (UCL or â&#x20AC;&#x2DC;worst case scenarioâ&#x20AC;&#x2122;).
30
Days
In order to drill down further and to understand the variability that might be concealed by looking at average length of stay, the next view provided by the tool displays an SPC type run chart of the most recent 100 patients discharged for the selected Consultant.
UCL 12.3 Days
Comparison with the UCL enables you to understand what the natural range of variation in length of stay is for the selected consultant. It also enables you to pick out the patients with much longer than expected length of stay and if necessary enable investigation as to the reasons behind this.
The final view provided by the tool gives further detail on the most recent 100 patients discharged as used in the run chart above.
Last 100 Primary Hip Replacement Patients Discharged for Consultant CXXXXXX Source: SUS Extracts, OPCS W371, W381, W391 on admitting episode
Admission / Operation / Discharge Profile by Day of Week 90% 80%
Admission Operation
70%
Discharge
60% 50% 40% 30% 20%
The first view is a bar chart providing a visual representation of the admission, operation and discharge practice of the selected consultant by day of week.
10% 0%
The second part is a simple listing of the 100 patients with Admission Operation Discharge Age Sex OPCS Procedure LoS their admission, operation and 06/07/2005 06/07/2005 11/07/2005 80 W371 Total prosthetic replacement of hip joint using cement, Primary total 5 discharge dates. Specifically prosthetic replacement of hip joint using cement 08/07/2005 08/07/2005 11/07/2005 56 W381 Total prosthetic replacement of hip joint not using cement, Primary 3 patient identifiable information total prosthetic replacement of hip joint not using cement 02/08/2005 03/08/2005 06/08/2005 73 W381 Total prosthetic replacement of hip joint not using cement, Primary 4 is excluded, however, there is total prosthetic replacement of hip joint not using cement 05/08/2005 05/08/2005 09/08/2005 70 W381 Total prosthetic replacement of hip joint not using cement, Primary 4 enough detail to enable a total prosthetic replacement of hip joint not using cement Total prosthetic replacement of hip joint using cement, Primary total 11/08/2005 11/08/2005 05/09/2005 91 W371 25 Consultant to cross reference prosthetic replacement of hip joint using cement their own records and 07/10/2005 07/10/2005 10/10/2005 77 W381 Total prosthetic replacement of hip joint not using cement, Primary 3 with total prosthetic replacement of hip joint not using cement investigate where a patient may 14/10/2005 14/10/2005 18/10/2005 68 W381 Total prosthetic replacement of hip joint not using cement, Primary 4 total prosthetic replacement of hip joint not using cement have had an exceptionally long length of stay. This element will be developed further in the next iteration to include flags to highlight those patients with complications associated with surgery and those with an emergency readmission. Mon
Tue
Wed
Thur
Fri
Sat
Sun
For more information on this tool please contact simon.berry@southeastcoast.nhs.uk
=
eÉäéáåÖ=ÑêçåíäáåÉ=ëí~ÑÑ=áååçî~íÉ=~åÇ=áãéêçîÉ=ëÉêîáÅÉë=
bå~ÄäáåÖ= = = = = = = = = = = pìééçêíáåÖ== = = = = = = = = = ^ÇîáëáåÖ= = = = = = = = = =
_ÉåÅÜã~êâáåÖ= kÉíïçêâáåÖ= `çää~Äçê~íáçå= aÉîÉäçéãÉåí=çÑ=jÉíêáÅë= aÉîÉäçéãÉåí=çÑ=pâáääë= aÉîÉäçéãÉåí=çÑ=qççäë= pí~íáëíáÅ~ä=qÉÅÜåáèìÉë= mêÉëÉåí~íáçå=C=fåíÉêéêÉí~íáçå= a~í~=pçìêÅÉë=C=`çääÉÅíáçåë= Quality Observatory NHS South East Coast York House 18-20 Massetts Road Horley,Surrey, RH6 7DE Phone: 01293 778899 E-mail: Quality.Observatory@SouthEastCoast.nhs.uk Website: www.QualityObservatory.nhs.uk To contact a team member: firstname.surname@southeastcoast.nhs.uk
ïïïKnì~äáíólÄëÉêî~íçêóKåÜëKìâ=