附录I: NHS England Statistics (Measures)

The following summary of NHS Statistics, although developed for England, has potential applicability to a Performance Management Initiative in the United States or any other country that practices Western medicine. For example, a particular hospital in the United States may need to improve the performance of its ambulance service—an area that the NHS has addressed in detail. The NHS measures dealing with ambulance service performance might not be the perfect solution, but they will at least provide starting points upon which you can build.

What follows are highlights of the specific statistics. Fortunately, the open NHS system provides details of every measure, including excluded populations, all available through the www .enghand.nhs.uk website. Also, the source information from which the information listed below is excerpted is available through the Statistical Work Areas page of the NHS website, www.england .nhs.uk/statistics/statistical-work-areas.

Accident and emergency attendances and emergency admissions

 Weekly and monthly accident and emergency (i.e., ER) attendances and admissions. Total number of attendances in the specified period for all A&E types, including Minor Injury Units and Walk-in Centers, and of these, the number of patients discharged, admitted, or transferred within 4 hours of arrival. Also included are the number of emergency admissions and any waits of over 4 hours and over 12 hours for admission following a decision to admit.

Ambulance systems indicators

The total number of Red 1 calls (i.e., top priority ambulance calls for cardiac/respiratory arrest victims) resulting in an emergency response arriving at the scene of the incident, the number of calls resulting in an emergency response arriving at the scene of the incident within 8 minutes, and the proportion of ambulances that responded to within 8 minutes.

The total number of Red 2 calls (i.e., second priority ambulance calls for life-threatening emergencies other than cardiac/respiratory arrest) resulting in an emergency response arriving at the scene of the incident, the number of calls resulting in an emergency response arriving at the scene of the incident within 8 minutes, and the proportion of ambulances that responded to within 8 minutes.

The total number of Category A calls (i.e., urgent, not life threatening) resulting in an emergency response arriving at the scene of the incident, the number of calls resulting in an emergency response arriving at the scene of the incident within 19 minutes, and the proportion of ambulances that responded to within 19 minutes.

Also, responsiveness of the switchboard to calls for an ambulance, by level of emergency/ urgenc.

Ambulance clinical outcomes quality indicators

   Cardiac Arrest

The number of patients resuscitated by ambulance service following an out-of-hospital cardiac arrest, the number of these patients who had return of spontaneous circulation on arrival at hospital, and the proportion of those who were resuscitated who had return of spontaneous circulation on arrival at hospital.

The number of patients resuscitated by ambulance service following an out-of-hospital cardiac arrest, where the initial rhythm was ventricular fibrillation or ventricular tachycardia, the number of these patients who had return of spontaneous circulation on arrival at hospital, and the proportion of those who were resuscitated who had return of spontaneous circulation on arrival at hospital.

Acute ST-elevation myocardial infarction (STEMI)

The number of patients with STEMI who received primary angioplasty, where ambulance personnel performed the first diagnostic ECG and patient was transferred to a primary percutaneous coronary intervention (PPCI) center.

The number of patients with STEMI who received primary angioplasty, where ambulance personnel performed the first diagnostic ECG and patient was transferred to a primary percutaneous coronary intervention (PPCI) center, and primary angioplasty balloon inflation occurred within 150 minutes of emergency call.

The proportion of patients with suspected STEMI confirmed on ECG who received appropriate care.

Stroke

Measures of the number of patients potentially eligible for stroke thrombolysis, including those arriving at hospitals with a stroke center within 60 minutes of a call to the ambulance service. Measures of the number of suspected stroke or unresolved transient ischemic attack patients, including those who received appropriate care, as well as the resultant proportion of suspected stroke or unresolved transient ischemic attack patients who received appropriate care.

Cardiac Arrest

The number of patients who had resuscitation started or continued by the ambulance service following

– An out-of-hospital cardiac arrest, discharged from hospital alive

– An out-of-hospital cardiac arrest of presumed cardiac origin, where the arrest was bystander witnessed and the initial rhythm was ventricular fibrillation or ventricular tachycardia

– An out-of-hospital cardiac arrest of presumed cardiac origin, where the arrest was bystander witnessed and the initial rhythm was ventricular fibrillation or ventricular tachycardia, who were discharged from the hospital alive

Bed availability and occupancy

   Occupancy rates and bed numbers.

Cancelled elective operations

    The number of last-minute elective operations cancelled for nonclinical reasons, and the number of patients not treated within 28 days because of last-minute elective cancellation.

Cancer patient experience survey

    Survey on patient experience with cancer treatment.

Cancer waiting times

    Waiting time by type of cancer.

Child immunization

    Child immunization statistics.

Combined performance summary

Monthly summary of NHS 111, ambulance quality indicators, A&E attendances and emergency admissions, waiting times, and delayed transfers of care.

Consultant-led referral to treatment waiting times   

   Median wait times for a referral, in weeks.

Critical care bed capacity and urgent operations cancelled

Critical care capacity, including adult, pediatric, and neonatal available and occupied critical care beds, as a snapshot at midnight on the last Thursday of the month. Also, the number of urgent operations cancelled, including those cancelled for the second or more time throughout the month.

Delayed transfers of care

   Average daily rate of delayed transfers of care.

Dementia assessment and referral

The number and proportion of patients 75+ admitted as an emergency for more than 72 hours who have been identified as potentially having dementia, who are appropriately assessed and, where appropriate, referred on to specialist services.

Diagnostic imaging data set

Measures of diagnostic imaging tests, extracted from Radiology Information Systems (RISs), including referral source and patient type, type of test, GP registered practice, patient postcode, ethnicity, gender and date of birth, plus waiting times for each diagnostic imaging event.

Diagnostic test waiting times and activity

A monthly measure of waiting times and activity for 15 key diagnostic tests and procedures, a quarterly measure of patients waiting over 6 weeks for a diagnostic test, and an annual measure of the number of imaging and radiological examinations or tests carried out during the year.

Direct access audiology waiting times

Referral to treatment (RTT) times for completed pathways and incomplete pathways for direct access audiology. That is, how long a patient has to wait for care after a referral.

Early intervention in psychosis waiting times

This measure is used to evaluate waiting time for patients who have started treatment for early intervention in psychosis, by week since referral.

Extended access to general practice

This biannual (six monthly) statistic looks at a general practice’s provision for pre-bookable appointments during extended hours on weekdays and weekends.

General practice (GP) patient survey

This survey catalogs the overall patient experience with the GP, access to in-hours GP services, assessment of online GP services, waiting times, patient confidence and trust in the GP, the operating hours of the GP, the patient’s overall health management, and the assessment of care planning.

General practice patient survey: dental results

This survey includes the number of visits to dentists in last 2 years per patient, patient preference for a private dentist over an NHS dentist, and the patient’s overall access to dental care.

Hospital activity

Monthly and quarterly reports of hospital inpatient and outpatient activity. Monthly reports include inpatient elective ordinary, elective day cases, elective ordinary planned, elective day case planned, and outpatient general practice written referrals made and seen. Quarterly reports include decisions to admit, patients admitted, patients failed to attend, outpatient number of general practice written referrals, first attendances seen, and subsequent attendances seen and did not attend.

Mental health community teams activity

A quarterly report on the number of patients on Care Program Approach followed up within 7 days of discharge from psychiatric inpatient care. Also, the number of inpatient admissions kept by Crisis Resolution Home Treatment teams.

Mixed sex accommodation breaches

The number of occurrences of unjustified mixing of sexes in relation to sleeping accommodation (i.e., mixing males and females in the same room/area).

National patient and staff surveys

A national patient survey on experience with primary care, secondary care, cancer, and overall satisfaction with the NHS system.

A national staff survey that includes an assessment of attitude, perceived discrimination, opportunities, and work versus home life.

NHS 111 minimum data set

Statistics on calls to “111” (roughly equivalent to “911” in the United States), including the number of calls, the average and maximum wait times, the number of calls transferred up the clinical hierarchy, the average length of calls, and whether an ambulance was dispatched in response to the call.

NHS staff survey in England

   An extensive staff survey.

Overall patient experience scores

Patient views of care and services provided by the NHS. Constructed using results taken from the NHS Inpatient, Outpatient, Community Mental Health, and Accident & Emergency surveys.

Patient reported outcome measures (PROMs)

The quality of care delivered to NHS patients, from the patient perspective, on four clinical procedures: hip replacements, knee replacements, groin hernia, and varicose veins. PROMs calculate the health gains after surgical treatment using pre- and postoperative surveys.

Venous thromboembolism (VTE) risk assessment

The number of adults admitted as inpatients in the month who have been risk assessed for VTE on admission to hospital, the total number of adult inpatients admitted in the month, and the percentage of adult hospital admissions assessed for risk of VTE on admission.

Winter daily situation reports

    Winter Accident and Emergency closures, cancelled operations, bed pressures, and ambulance delays.

Source: https://www.england.nhs.uk/statistics/statistical-work-areas