Gastroenterology Service Free Papers: Hall 1C (09:03 AM)

BSG Annual Meeting

Liverpool ACC, Tuesday 5th June 2018

Benchmarking of activity, process and

outcome of emergency admission for
ulcerative colitis across English hospitals
Mustafa Shawidhi 1, Susanna Dodd 1, Duncan Appelbe 1, Pete Dixon 1,
Ruth Grainger 1, Fraser Cummings 2, Stuart Bloom 3 and Keith Bodger 1
1. Department of Biostatistics, University of Liverpool
2. University Hospitals Southampton
3. University College London Hospital
 BACKGROUND

• The UK IBD Registry aims to make information work better for patients, clinical
teams and the NHS

• As part of the benchmarking reports provided to participating Trusts, we have

developed organisational level metrics from routinely collected Hospital Episode
Statistics (HES) data – working with front-line teams to iteratively develop reports
with feedback on content and local face-validity

• We report national-level findings and institutional variation in activity, process and

outcome of emergency care for UC
 METHODS

• Analysis of five years of HES data for English hospitals (2011/12 to 15/16)

• 133 Acute Trusts with no change to organisation’s status

• Select patients ‘ever’ coded with a diagnosis of UC, extract all-cause admissions

• Focus on emergency admissions where the primary diagnosis recorded was UC

• Additional analyses of admissions with other relevant diagnoses (‘non-primary’)

• Case mix variables (age, sex, co-morbidity)

• Activity and Process metrics (admissions, bed days, length of stay)

• Outcome metrics (surgery; in-hospital death; 30-day emergency readmission)

 METHODS

IBD REGISTRY HES REPORTS

 METHODS

IBD REGISTRY HES REPORTS

 METHODS

IBD REGISTRY HES REPORTS

 RESULTS

Emergency Admission With A Primary Diagnosis of Ulcerative Colitis

Between 2011/12 to 2015/16

22,809 patients
 RESULTS

31,371
Mean: 40 years
Emergency Admissions

50:50 Median LOS: 6 days

22,809 patients

Co-Morbidity 265,799 bed days

23%
 RESULTS
Nationally (5 Years)
30-day

4.6% 1.0% 15.7%

 RESULTS
Nationally (5 Years)
30-day

4.6% 1.0% 15.7%

400 6. 0
C ou nt Pe rce ntag e
350
5. 0
300 5.0
4.8
4.4 4. 0
250 4.3

200 3. 0
3.1
150
2. 0
100
1. 0
50
327 337 295 328 244
0 0. 0
201 1- 12 201 2- 13 201 3- 14 201 4- 15 201 5- 16
 RESULTS

14. 00
F irst M ajo r S u rg ery D u rin g S am e A d m issio n (C ru d e % )

12. 00

10. 00

D a ta

8 .0 0 Av e
r a g
e

2 S D li m its

3 S D li m its
6 .0 0

4 .0 0

2 .0 0

0 .0 0
0 10 0 20 0 30 0 40 0 50 0 60 0 70 0

U C S p ecific E m erg en cy A d m issio n s

 RESULTS
Nationally (5 Years)
30-day

4.6% 1.0% 15.7%

C ou nt Pe trce ntag e
90 1.13 1.20
1.10
80 1.02 1.00
70
0.84
60 0.76 0.80
50
0.60
40
30 0.40
20
0.20
10 72 80 71 62 59
0 0.00
20 11-12 20 12-13 20 13-14 20 14-15 20 15-16
 RESULTS

3 .5 0
In -H o sp ital D eath D u rin g S am e A d m issio n (C ru d e % )

3 .0 0

2 .5 0
D a ta

Av e
r a g
e
2 .0 0
2 S D li m its

3 S D li m its

1 .5 0

1 .0 0

0 .5 0

0 .0 0
0 10 0 20 0 30 0 40 0 50 0 60 0 70 0

U C S p ecific E m erg en cy A d m issio n s

 RESULTS

4
Rate per 100,000 Standard Population

2
per Year"

0
0 50 00 0 10 00 00 15 00 00 20 00 00 25 00 00
Data Avera ge 2S D l i mits 3S D l i mits Upp er 3S d l m
i it

Indirect standardisation for age, gender and co-morbidity (Charlson)

 RESULTS
Nationally (5 Years)
30-day

4.6% 1.0% 15.7%

Co un t Pe rcenta ge
140 0 18. 0

15.7 16.3 16. 0

120 0 15.2 15.6
14.5 14. 0
100 0
12. 0
800 10. 0

600 8. 0

6. 0
400
4. 0
200
2. 0
998 1111 1132 1148 1130
0 0. 0
20 11-12 20 12-13 20 13-14 20 14-15 20 15-16
 RESULTS
30-day

26. 00
E m erg en cy R ead m issio n W ith in 30 D ays (C ru d e % )

24. 00

22. 00

20. 00 D a ta

Av e
r a g
e

18. 00 2 S D li m its

3 S D li m its

16. 00

14. 00

12. 00

10. 00

8 .0 0
0 10 0 20 0 30 0 40 0 50 0 60 0 70 0

U C S p ecific E m erg en cy A d m issio n s

 CONCLUSIONS

• These data provide real-world insights into processes and outcomes of

emergency care for UC across England in the last five years, with a series of
metrics to support both national and local quality improvement efforts

• Linkages between HES and local Registry data offers potential to validate,
refine and extend these benchmarking metrics
ACKNOWLEDGEMENTS

Health Services Development Award

The late Richard Driscoll with Mustafa (picture courtesy of BSG)