Explanatory Notes for Acute Episode-Based Activity Statistics

General Notes

The information presented in Acute Episode-Based Activity Statistics is sourced from the Hospital Inpatient System. The data relate to all episodes within the Acute Programme of Care (PoC 1). Activity recorded under Maternity & Child Health, Elderly Care, Mental Health and Learning Disability (PoCs 2, 4, 6 and 7) is excluded. In addition, from 2008/09, Independent Sector activity carried out within HSC hospitals is excluded. Provided information is based on finished consultant episodes (FCEs). Only those episodes that ended during or before the final day of the financial year (31st March) are included in the figures provided for that year. However, episodes that began in a previous year (i.e. prior to 1st April) but ended during the year under consideration will be included.

The Hospital Inpatient System (HIS)

The HIS provides information on admitted patient care delivered by Health and Social Care Hospitals in Northern Ireland. It is a patient-level administrative data source and each record relates to an individual consultant episode. During a single hospital admission, a patient may be transferred from the care of one consultant to another, generating an additional consultant episode. Episode-based data is therefore not equivalent to admission-based data, as each admission may be made up of one or more consultant episodes. The HIS records information on patients admitted to acute hospitals as inpatients or day cases. It does not hold information on patients attending hospital as outpatients or who attended an Emergency Care Department and were not admitted, nor does it hold details of patients treated in the Primary Care setting. The HIS also does not hold details of patients admitted under any psychiatric or mental health specialties.

Data Availability

The HIS contains over half a million records for each year but, because those relate to individual admitted patients, it is not possible to allow direct, unsupervised access to them. Many questions can, however, be answered by summarising the data. For example, ‘How many admissions were there for heart attacks?’ or, ‘What was the average number of days spent in hospital for patients undergoing a coronary artery bypass graft?’ As the data are of general interest, Hospital Information Branch publishes tables that can be downloaded free of charge from this site. Subject to resources and data confidentiality requirements, it may be possible for the Branch to provide data breakdowns beyond the scope of the tables available or to provide presentation of the data in a different format. If you require such additional information, please contact us at statistics@health-ni.gov.uk. If you require access to the entire dataset for research purposes, you may submit an application to the Honest Broker Service. Further information on eligibility and the processes involved is available on their website http://www.hscbusiness.hscni.net/services/2454.htm Please exercise care when comparing HIS figures across time, as fluctuations in the data can occur for a number of reasons, for example organisational changes, reviews of best practice within the medical community, the adoption of new coding schemes and data-quality problems that are often year-specific. These variations can lead to false assumptions about trends. We advise users of time series data to carefully explore the relevant issues before drawing any conclusions about the reasons for year-on-year changes.

Published Data

Details of all episode-based data that are currently freely available from this website are provided below.

HTML format publication

• Acute Episode-Based Activity Statistics Volume 1: Specialty
• Acute Episode-Based Activity Statistics Volume 2: Diagnoses
• Acute Episode-Based Activity Statistics Volume 3: Procedures / Operations
• Acute Episode-Based Activity Statistics Volume 4: Healthcare Resource Group (HRG)

The HTML is prefaced by a summary of activity by admission type and age bands.

Downloadable data

The data presented in the HTML publication is available for download in Excel format.

Acute Episode Based Activity Statistics Headline Figures

These tables give overview totals for the year, broken down by admission type (emergency, planned, etc.) and age bands.

Acute Episode Based Activity Statistics Volume 1: Specialty

The specialty reflects that of the consultant with prime responsibility for the patient. The specialties, recognised by the Royal Colleges and Faculties, reflect broad ranges of skills and expertise and provide a quick summary of areas of treatment. The specialty codes consist of three numbers and are followed by a description.

Acute Episode Based Activity Statistics Volume 2: Diagnoses

Diagnoses are recorded using International Classification of Diseases 10th Revision (ICD-10) codes. Each episode may have a primary diagnosis (the main condition treated or investigated during the episode of care) and up to sixteen secondary diagnoses.

This set of tables includes 3 components:

1. A summary of activity by primary diagnosis chapter and block

   • This groups together broadly associated diagnosis codes into blocks, which may be grouped into chapters. The codes in each chapter and block are at a 3-character level that consists of a letter followed by two numbers (such as ‘A00’) and are accompanied by a complete description of the diagnosis group.

   • Note that the same diagnosis will be included in two groupings – both in a chapter and a block within that chapter. For example, the ICD-10 code ‘A00 – Cholera’ appears within the chapter grouping, ‘I – Certain infectious and parasitic diseases (A00-B99)’ and in the block, ‘A00-A09 – Intestinal infectious diseases’.

2. Activity for each primary diagnosis code (at the 3-digit level)

3. Activity for each diagnosis code (at the 3-digit level), regardless of position

Acute Episode Based Activity Statistics Volume 3: Procedures / Operations

Procedures / interventions are recorded using OPCS codes. Each episode may have a primary procedure / intervention and up to twelve secondary procedures / interventions.

This set of tables includes 3 components:

1. A summary of activity by primary procedure / intervention chapter and block

   • This groups together OPCS codes into blocks and chapters in line with the OPCS structure. The codes in each chapter and block are at a 3-character level that consists of a letter followed by two numbers (such as ‘A02’) and are accompanied by a complete description of the procedure / intervention group.

   • Note that the same procedure / intervention will be included in two groupings – both in a chapter and a block within that chapter. For example, the OPCS code ‘A02 – Excision of lesion of tissue of brain’ appears within the chapter grouping, ‘A – Nervous System (A01-A84)’ and in the block, ‘A1 – Tissue of brain (A01-A10)’.

2. Activity for each primary procedure / intervention code (at the 3-digit level)

3. Activity for each procedure / intervention code (at the 3-digit level), regardless of position

Acute Episode Based Activity Statistics Volume 4: Healthcare Resource Group (HRG)

Healthcare Resource Groups (HRGs) are standard groupings of clinically similar treatments that use common levels of healthcare resource. The table contains data and descriptions relating to episodes grouped according to HRG version 4. The abbreviation “CC” is used in this table to refer to complications and comorbidities.

Glossary of Terms for Acute Episode-Based Activity Statistics

Finished Consultant Episode (FCE)

A period of continuous admitted patient treatment under the care of a consultant. An episode may be finished through death, discharge or transfer to the care of another consultant or hospital. If the patient is transferred from one consultant to another, a new FCE commences.

Admissions

Total admissions has been taken to be the sum of all day cases, inpatients (elective and non elective) and regular attenders. Deaths and discharges have been used as an approximation for admissions.

Day Case

A patient admitted electively during the course of a day with the intention of receiving care, who does not require the use of a hospital bed overnight and who returns home as scheduled. If this original intention is not fulfilled and the patient stays overnight, such a patient should be counted as an inpatient.

Elective Inpatient

A patient for whom the decision to admit could be separated in time from the actual admission. This excludes emergency admissions and maternity or delivery episodes.

Non-elective Inpatient

A patient for whom admission is unpredictable and at short notice, due to clinical need.

Emergency Admission

An emergency admission may be by various routes, including through an Emergency Care Department and via a General Practitioner.

Waiting List Admission

A patient is admitted electively from a waiting list having been given no date of admission at a time a decision was made to admit.

Bed day

A day of bed occupation by an admitted inpatient (beds used for day case admissions and regular day / night attenders are not included). For example, if there are 100 inpatients who each remain in hospital for 5 days, the bed days figure will be 500.

The total number of bed days in Acute Episode-Based Activity Statistics has been calculated using the episode duration field within the Hospital Inpatient System; this is in contrast to the Inpatient and Day Case Activity Statistics publication which uses specialty-level bed occupancy data from the KH03a aggregate return.

Primary Diagnosis

The condition established as the main reason for admission after all investigations, diagnostic examinations and procedures have been carried out.

ICD-10

The International Classification of Diseases 10th Revision (ICD-10) is used to translate the diagnoses of diseases and other health problems into an alphanumeric code. The International Classification of Diseases is published and maintained by the World Health Organization, Geneva.

OPCS

OPCS (Office of Population Censuses and Surveys) coding is the classification of surgical operations and procedures. OPCS-4 codes consist of a letter followed by 3 figures. The letters denote the 22 Chapters of the classification, each chapter dealing with a different part, or ‘system,’ of the body.

Specialty

A specialty is a particular branch of medicine or surgery. Each consultant is assigned a main specialty from a list recognised by the Royal Colleges and Faculties. Information is recorded against the specialty of the treating consultant.

HRG

Healthcare Resource Groups (HRGs) are standard groupings of clinically similar treatments which use common levels of healthcare resource.

Procedure/Intervention

A procedure or series of procedures aimed at restoring or improving the health of a patient, as by correcting a malformation, removing diseased parts, implanting new parts, etc. Defined by an OPCS code recorded in any of the procedure fields in the Hospital Inpatient System excluding codes Y80, Y81, Y82, Y84, Y90 and all Z codes.

Operation

An OPCS code recorded in any of the procedure fields the Hospital Inpatient System excluding all Y and Z codes.

Chapters/Blocks

The diagnosis and operations tables group associated diagnosis/procedure codes into chapters and blocks (i.e. sub chapters) in line with those designated by the World Health Organisation/OPCS respectively.

Purpose

This publication presents information on acute, episode-based activity at Health and Social Care Trusts in Northern Ireland during the year ending 31 March 2023. It details key information on all acute activity and provides a breakdown of activity by specialty.

The data contained in this publication have been compiled from the Hospital Inpatient System (HIS), introduced from 1st April 2009.

Data detailed in this publication are available in spreadsheet format (Microsoft Excel) to aid secondary analysis, at the link https://www.health-ni.gov.uk/publications/acute-episode-based-activity-downloadable-data-202223

Explanatory notes and a glossary of terms are available from the link https://www.health-ni.gov.uk/publications/explanatory-notes-and-technical-guidance-acute-episode-based-activity

Please note that finished episodes in tables 6, 7, 8 and 9 will not sum to the finished episode totals due to incomplete coding of a small number of records.

COVID-19 is included in code U07 within chapter XXII of the diagnosis table.

Statistical Quality: Information detailed in this release is a more detailed breakdown of the Inpatient and Day Case Activity publication (released August 2023) that was quality assured with HSC Trusts prior to release.

Published by: Hospital Information Branch, Information & Analysis Directorate, Department of Health

Statisticians: Stephanie Anderson, Jenny Finlay, Siobhán Morgan

Contact: statistics@health-ni.gov.uk

Reporting Period: 1st April 2022 – 31st March 2023

Publication Date: 5th October 2023

Date of Next Publication 3rd October 2024

Coverage: Northern Ireland

Frequency: Annually

Copyright: This publication is Crown copyright and may be reproduced free of charge in any format or medium. Any material used must be acknowledged, and the title of the publication specified.

About Hospital Information Branch

Hospital Information Branch is responsible for the collection, quality assurance, analysis and publication of timely and accurate information derived from a wide range of statistical information returns supplied by the Health & Social Care (HSC) Trusts. Statistical information is collected routinely from a variety of electronic patient level administrative system and pre-defined EXCEL survey return templates.

The Branch aims to present information in a meaningful way and provide advice on its uses to customers in the HSC Committee, Professional Advisory Groups, policy branches within the DoH, other Health organisations, academia, private sector organisations, charity/voluntary organisations as well as the general public. The statistical information collected is used to contribute to major exercises such as reporting on the performance of the HSC system, other comparative performance exercises, target setting and monitoring, development of service frameworks as well as policy formulation and evaluation. In addition, the information is used in response to a significantly high volume of Parliamentary / Assembly questions and ad-hoc queries each year.

Information is disseminated through a number of key statistical publications, including: Inpatient Activity, Outpatient Activity, Emergency Care, Mental Health & Learning Disability and Waiting Time Statistics (Inpatient, Outpatient, Diagnostics and Cancer). These publications are available from the website https://www.health-ni.gov.uk/topics/dhssps-statistics-and-research

Further information on the Acute Episode-Based Activity data, including definitions, is available from the website https://www.health-ni.gov.uk/articles/episode-based-activity