What the data can tell us? - Royal College of Surgeons in ... Gerry Kelliher.pdf · What the data can tell us? 1 ... Acute Lap & Open Appendectomy volumes & AvLOS by Qtr, 2015

What the data can tell us?

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1 NCPS Feb 2017

Mr Gerry Kelliher, Business Intelligence, National Clinical Programme in Surgery [email protected] // 087 124 0759

mailto:[email protected]

2 NCPS use HIPE data for reports - Confidential

Surgery Discharges between 2010 and 2015 (including Acute and Elective admissions for surgery or surgical care

excludes obstetrics, maternity hospitals, hospices and rehab units)

Note: New 2015 surgical procedure map table reapplied to all yearly analysis 2010 … 2015

Comparing 2015 to 2010

54,032 more cases treated in 2015

87,561 less bed days needed

122,172 less overnight stay bed days but

69,222 more day cases require 34,611 more day bed days

Without these improvements

An extra 54,032 more cases in 2015

Would require 242,372 more bed days

Or 2 more model 3 hospitals

Dedicated to surgery

We DID great

• Data Informed Decision making in delivering quality improvement as iterative cycles

– Leveraging HIPE data

• Projected population changes and their impact on activity and bed requirement

– Leveraging CSO data combine with HIPE data

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3 NCPS uses HIPE & CSO data Feb 2017

“Facts do not cease to exist because they are ignored” – Aldous Huxley

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4 NCPS Feb 2017

D M A I C

Define the problem or area you want to focus on

NQAIS summary report, …

Measure what is happening now, Variance analysis

NQAIS Plots, Grid, …

Analyse the problem, Ishikawa (root cause analysis),

Pick & scope the Quality Improvement initiative

Data driven decision making, …

Implement quality improvement initiative

Control Verify desired impact, adjust as necessary &

sustain NQAIS …

People working together deliver Quality

Improvement

5 NCPS uses HIPE data Feb 2017

Total Hip Replacement – Elective discharge Volumes and AvLOS by quarter 2010 to 2015

AvLOS: 8.8 7.7 8.7 6.3 5.6 5.5

AvLOS: 8.5 8.4 6.6 6.4 6.0 5.5 AvLOS: 8.7 7.9 5.3 5.1 5.2 5.8

AvLOS: 9.1 8.4 5.1 4.7 4.7 4.6

Avg. 1 day less

Trending upwards

Quality Improvement

variance

Hospital 1 Hospital 2

Hospital 3 Hospital 4

6 NCPS Feb 2017

60% Nat.

Target

60% Nat.

Target

Elective Lap Chole. day case rate 4 individual hospitals by Qtr 2010 … 2015 M4 – above target M4 (with associate M2’s) – off target

M2S (highest volume) – off target M3 (best improver) – above target

Quality Improvement

variance


ProcDesc (Code) Inpat BDU AvLOS Inpat BDU AvLOS

Laparoscopic appendicectomy (3057200) 3,760 11,802 3.1 76 142 1.9 71 3,907

Appendicectomy (3057100) 437 2,240 5.1 12 51 4.3 4 453

Grand Total 4,197 14,042 3.3 88 193 2.2 75 4,360

Acute Elective

Day CasesTotal

Discharges

National Laparoscopic and Open Appendicectomy volumes & AvLOS by Hospital, 2015 - Adults

Hospital Groups

Individual Hospital

NQAIS Surgery enables tracking of Comparative AvLOS by Hospital, Acute AvLOS from Nov’15 to Oct’16

2.36 4.00

3.84

2.52

Quality Improvement

variance

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1.64 day difference In AVLOS

1.32 day difference In AVLOS

M4 – Higher AvLOS (4.0) M3 – Lower AvLOS (2.36)

M3 – Higher AvLOS (3.84) M3 – Lower AvLOS (2.52)

Acute Lap & Open Appendectomy volumes & AvLOS by Qtr, 2015

Same Hospital Group

Same Hospital Group


NQAIS Surgery can be used to support process improvement – 4 consultants – Tonsil DC rate

0.0% Clinician 1

Clinician 2

Clinician 3

Clinician 4

Dec’15-Nov’16

0.5%

Quality Improvement opportunity - variance

18.9%

54.8%

Variance analysis – Red bed days


D M A I C


Improvement Decision Making After Informed Choices

Ireland’s population is increasing and ageing.

Will increasing population age impact on capacity?

Ireland population census of 2011 Projected to 2040 by gender and age

Ireland population census of 2011 Projected by age in five year increments

Age Bands

6 million

5 million

4 million

3 million

2 million

1 million

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11 NCPS uses CSO data Feb 2017 11

5.0 5.3

4.7/4.8

5.6

20.2% increase

Age Bands

Age Bands

2015 Bed Days Used by age band projected 2015 discharges by age band projected

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12 NCPS uses HIPE and CSO data in combination Feb 2017

We can see the impact of population change on hospital bed resources Using HIPE actuals for 2015 & CSO population projections 2011

Note: actual stay LOS & 0.5 days for same day / day cases

52.6% increase 86.3% increase Specialties: All surgical, medical, paediatric and other specialties

Age Bands



What does Surgery look like Using HIPE actuals for 2015 & CSO population projections

Specialties: All surgical specialties

47.5% increase 73.2% increase

Age Bands

Age Bands


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What does General Surgery look like Using HIPE actuals for 2015 & CSO population projections

Specialties: Breast Surgery, Gastro-Intestinal Surgery, General Surgery, Hepato-Biliary Surgery and Vascular Surgery


Age Bands

Age Bands

Age Bands


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What does Trauma Orthopaedic Surgery look like Using HIPE actuals for 2015 & CSO population projections

Specialties: Orthopaedic and Paediatric Orthopaedic Surgery


Age Bands

Age Bands


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What does Gynaecology look like Using HIPE actuals for 2015 & CSO population projections

Specialties: Orthopaedic and Paediatric Orthopaedic Surgery


Age Bands

Age Bands


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What does Urology Surgery look like Using HIPE actuals for 2015 & CSO population projections

Specialties: Urology and Paediatric Urology


Urology is mostly day case activity (LOS 0.5)

Age Bands

Age Bands



What does Otolaryngology (ENT) Surgery look like Using HIPE actuals for 2015 & CSO population projections

Specialties: Otolaryngology (ENT) and Paediatric ENT


Otolaryngology is mostly day case activity (LOS 0.5)

Surgery Demand into the future

• There will be a 47.5% surgery patients due to demographic pressures by 2046 (BDU 73.2%)

• Not all specialties will be impacted at the same rate

– Capacity planning

– Workforce alignment

• Needs further analysis because

– Initial analysis crude

– Does not anticipate technology advancement, etc

– Includes external migration trends but not internal (eg. urbanisation)

– Are there differing demand growths by Sex, Procedure and/or Diagnosis, … ?

19 NCPS Feb 2017

How do we configure our hospital for surgery in the future?

• Issues

– Trauma & Emergency

– Cancer treatment and other elective/planned activity

– Hospital Groups and CHO’s

• Location of service relative to the population?

– Surgical team’s

• What is a reasonable on-call rota?

• What is a reasonable workload?

– Trolleys v. Waiting lists v. Bed Occupancy (100% ?)

– Budgetary limitations

– The socio-political game

20 NCPS Feb 2017

NCPS 21 Feb 2017- Use HSE data

Information Decision Making

Action

Review and Control

Measure

“We DID great”

We have seen Data Informed Decision making in Quality Improvement.


Improvement

Thank You

• Any Questions?

Mr Gerry Kelliher, Business Intelligence, National Clinical Programme in Surgery [email protected] // 087 124 0759

22 NCPS Feb 2017

mailto:[email protected]

Backup slides

Tonsillectomy discharges by hospital by Qtr 2010 … 2015

ProcDesc (Code) Inpat BDU AvLOS Inpat BDU AvLOS

Tonsillectomy without adenoidectomy (4178900) 27 166 6.1 2,325 2,778 1.2 144 2,496

Tonsillectomy with adenoidectomy (4178901) 5 22 4.4 1,260 1,544 1.2 12 1,277

Adenoidectomy without tonsillectomy (4180100) 2 8 4.0 256 270 1.1 302 560

Arrest haemorrhage following T & A (4179700) 118 273 2.3 2 3 1.5 2 122

Acute Elective

Day CasesTotal

Discharges

2.7% HIPE recorded admission - Arrest haemorrhage following T&A Note: M4 above - Arrest haemorrhage following T&A above was 1.3%

High Volume Model 2 ≈ 1% day case rate

Model 4 - 63% day case rate (2015)

HIPE Activity 2015

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24 NCPS use HIPE data Feb 2017

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Age Bands

Age Bands



What does Adult Medicine look like Using HIPE actuals for 2015 & CSO population projections

Specialties: All Adult Medicine Specialties


Age Bands

Age Bands


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What does Obstetrics & Gynaecology Surgery look like Using HIPE actuals for 2015 & CSO population projections

Specialties: Gynaecology, Obstetrics, and Obstetric/Gynaecology (not all surgical in nature)


Age Bands

Age Bands



What does Geriatric Medicine look like Using HIPE actuals for 2015 & CSO population projections

Specialties: All Adult Medicine Specialties


? ? ? ?

NQAIS – a complex story – simply told

• Clinically focused

• Easily learnt & understood (user friendly)

• Important signals visible at a glance

• ~3 months in arrears, refreshed monthly

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Split by Procedure within Surgical Specialty

NCP / HIU / HIPE / OpenApp -> NQAIS

Split by CCS for diagnoses within

CCS group

NQAIS database

HIU process HIPE data

It is available to you

NQAIS Clinical Red beds/day

NQAIS Clinical evolves NQAIS Medicine & NQAIS Surgery

• Swap between diagnosis, procedures or clinical specialties

• Comparative metrics by diagnoses, procedures, specialties and/or clinicians

• Will facilitate understanding of complex relationships between diagnoses and procedures

• All Hospital InPatient Enquiry (Elective, Emergency, Maternity & Neonate)

• Improved Red bed summary, age group analysis, record selection, data explorer, …

Documents

What the data can tell us? - Royal College of Surgeons in ... Gerry Kelliher.pdf · What the data can tell us? 1 ... Acute Lap & Open Appendectomy volumes & AvLOS by Qtr, 2015