Urology basket

TURP Adjusted Average Length of Stay

Metric

Adjusted average length of stay for patients receiving a TURP.

Observed

Average length of stay- average of (Date of discharge- Date of admission)

• Inpatients only
• TURP Procedure Group-

Endoscopic resection of outlet of male bladder: OPCS code- M65

Expected

Expected length of stay is adjusted to indirectly standardise for differences in co-morbidities.

• Inpatients only
• TURP Procedure Group-

Endoscopic resection of outlet of male bladder: OPCS code- M65

Time frame

April 2009- March 2010

Basis

Acute Trust (excluding specialists)

Statistical methods used

Indirect standardisation, adjusted for:

• Co-morbidities (Dr Foster methodology, see Appendix, Charlson score)

Cystectomy: Crude Rate

Metric

The percentage of admissions that have a Cystectomy.

Numerator

Cystectomy: total excision of bladder - OPCS code: M34

Denominator

The episode with the dominant procedure was used in the analysis

Data Source

SUS - CDS

Time frame

SUS - April 2009- March 2010

Basis

Acute Trust

Statistical methods used

Crude rate

Prostatectomy open vs. closed

Metric

The proportion of Prostatectomy carried out laparoscopically and the proportion performed closed.

Numerator

Patients that received either a Laparoscopic Prostatectomy or an open Prostatectomy were obtained over the period 2007/08-2009/10 for analysis. The following codes were used:

Laparoscopic Prostatectomy OPCS codes - M61 (+ Y75)

Open Prostatectomy OPCS codes - M61

Logistic regression was applied to the data looking at the following factors:

• Age
• Sex
• Deprivation (not significant in the final model)
• Charlson score
• Admission type

Admissions that did not have a valid age, sex, admission type or deprivation score were excluded from the analysis.

Denominator

Elective admissions- Based on discharging episode with an admission method of one of the following:

• 11, Elective - from waiting list
• 12, Elective - booked
• 13, Elective - planned

The episode with the dominant procedure was used in the analysis (Defined in Appendix, dominant procedure episode)

Scrotal procedures: All procedures with a HRG 4 of LB34 Scrotum, Testis or Vas Deferens Open Procedures

Data Source / Time frame

April 2009- March 2010

Basis

Acute Trust

Statistical methods used

Case-mix adjusted using a logistic regression model.

Logistic regression

The ratio is calculated by dividing the actual number of closed Prostatectomies by the expected number and multiplying the figure by 100. It is expressed as a relative risk, where a risk rating of 100 represents the national average. If the trust has an RR of 100, that means that the number of patients who received a closed Prostatectomy is exactly as would be expected taking into account the standardisation factors. An RR above 100 means more patients received a closed Prostatectomy than would be expected; one below 100 means that fewer than expected were closed.

Logistic regression was applied to the data. Stepwise regression was also applied to the data.

Control limits

Control limits tell us the range of values which are consistent with random or chance variation. Data points falling within the control limits are consistent with random or chance variation and are said to display ‘common-cause variation’; for data points falling outside the control limits, chance is an unlikely explanation and hence they are said to display ‘special-cause variation’ - that is, where the trust’s rate diverges significantly from the national rate.

Scrotal procedures day case rate

Metric

Day case rate for scrotal procedures is defined as the percentage of patients who receive their procedure as a day case.

Numerator

Elective admissions- Based on discharging episode with an admission method of one of the following:

• 11, Elective - from waiting list
• 12, Elective - booked
• 13, Elective - planned

The episode with the dominant procedure was used in the analysis (Defined in Appendix A)

Day case- Classpat=2

Scrotal procedures: All procedures with a HRG 4 of LB34 Scrotum, Testis or Vas Deferens Open Procedures

Denominator

Elective admissions- Based on discharging episode with an admission method of one of the following:

• 11, Elective - from waiting list
• 12, Elective - booked
• 13, Elective - planned

The episode with the dominant procedure was used in the analysis (Defined in Appendix A)

Scrotal procedures: All procedures with a HRG 4 of LB34 Scrotum, Testis or Vas Deferens Open Procedures

Data Source / Time frame

April 2009- March 2010

Basis

Acute Trust

Statistical methods used

Crude rate

Standardised Readmission Ratio- Scrotal procedures

Metric

The ratio of the observed number of readmissions to the expected number of readmissions, multiplied by 100.

Numerator

All spells with an emergency readmission within 28 days of discharge.

Readmitting episode- Emergency admissions:

• 21, Emergency - via A&E
• 22, Emergency - via GP
• 23, Emergency - via Bed Bureau
• 24, Emergency - via Out-patient clinic
• 28, Emergency - via other means

Readmission date within 28 days of discharging spell

Group-

All procedures with a HRG 4 of LB34 Scrotum, Testis or Vas Deferens Open Procedures

Denominator

Expected number of readmission derived from logistic regression, adjusting for factors to indirectly standardise for differences in case-mix.

Adjustments are made for:

• Sex
• Age on admission (in five year bands up to 90+)
• Admission method (non-elective or elective)
• Socio-economic deprivation quintile of the area of residence of the patient (based on the Carstairs Index)
• Primary procedure
• Co-morbidities (Dr Foster methodology)
• Number of previous emergency admissions
• Year of discharge (financial year)
• Palliative care (whether the patient is being treated in specialty of palliative care)
• Month of admission
• Ethnicity
• Source of admission

Data Source / Time frame

April 2009- March 2010

Basis

Acute Trust

Statistical methods used

Logistic regression

The ratio is calculated by dividing the actual number of readmissions by the expected number and multiplying the figure by 100. It is expressed as a relative risk, where a risk rating of 100 represents the national average. If the trust has a SRR of 100, that means that the number of patients who were readmitted is exactly as would be expected taking into account the standardisation factors. A SRR above 100 means more patients were readmitted than would be expected; one below 100 means that fewer than expected were readmitted.

Control limits

Control limits tell us the range of values which are consistent with random or chance variation. Data points falling within the control limits are consistent with random or chance variation and are said to display ‘common-cause variation’; for data points falling outside the control limits, chance is an unlikely explanation and hence they are said to display ‘special-cause variation’ - that is, where the trust’s rate diverges significantly from the national rate.

Standardised Readmission Ratio- TURP

Metric

The ratio of the observed number of readmissions to the expected number of readmissions, multiplied by 100.

Numerator

All spells with an emergency readmission within 28 days of discharge.

Readmitting episode- Emergency admissions:

• 21, Emergency - via A&E
• 22, Emergency - via GP
• 23, Emergency - via Bed Bureau
• 24, Emergency - via Out-patient clinic
• 28, Emergency - via other means

Readmission date within 28 days of discharging spell

Procedure Group-

Endoscopic resection of outlet of male bladder: OPCS code- M65

Denominator

Expected number of readmission derived from logistic regression, adjusting for factors to indirectly standardise for differences in case-mix.

Adjustments are made for:

• Sex
• Age on admission (in five year bands up to 90+)
• Admission method (non-elective or elective)
• Socio-economic deprivation quintile of the area of residence of the patient (based on the Carstairs Index)
• Primary procedure
• Co-morbidities (Dr Foster methodology)
• Number of previous emergency admissions
• Year of discharge (financial year)
• Palliative care (whether the patient is being treated in specialty of palliative care)
• Month of admission
• Ethnicity
• Source of admission

Data Source / Time frame

April 2009- March 2010

Basis

Acute Trust

Statistical methods used

Logistic regression

The ratio is calculated by dividing the actual number of readmissions by the expected number and multiplying the figure by 100. It is expressed as a relative risk, where a risk rating of 100 represents the national average. If the trust has a SRR of 100, that means that the number of patients who were readmitted is exactly as would be expected taking into account the standardisation factors. A SRR above 100 means more patients were readmitted than would be expected; one below 100 means that fewer than expected were readmitted.

Control limits

Control limits tell us the range of values which are consistent with random or chance variation. Data points falling within the control limits are consistent with random or chance variation and are said to display ‘common-cause variation’; for data points falling outside the control limits, chance is an unlikely explanation and hence they are said to display ‘special-cause variation’ - that is, where the trust’s rate diverges significantly from the national rate.

Standardised Readmission Ratio- Cystectomy

Metric

The ratio of the observed number of readmissions to the expected number of readmissions, multiplied by 100.

Numerator

All spells with an emergency readmission within 28 days of discharge.

Readmitting episode- Emergency admissions:

• 21, Emergency - via A&E
• 22, Emergency - via GP
• 23, Emergency - via Bed Bureau
• 24, Emergency - via Out-patient clinic
• 28, Emergency - via other means

Readmission date within 28 days of discharging spell

Procedure Group-

Total excision of bladder - OPCS code: M34

Denominator

Expected number of readmission derived from logistic regression, adjusting for factors to indirectly standardise for differences in case-mix.

Adjustments are made for:

• Sex
• Age on admission (in five year bands up to 90+)
• Admission method (non-elective or elective)
• Socio-economic deprivation quintile of the area of residence of the patient (based on the Carstairs Index)
• Primary procedure
• Co-morbidities (Dr Foster methodology)
• Number of previous emergency admissions
• Year of discharge (financial year)
• Palliative care (whether the patient is being treated in specialty of palliative care)
• Month of admission
• Ethnicity
• Source of admission

Data Source / Time frame

April 2009- March 2010

Basis

Acute Trust

Statistical methods used

Logistic regression

The ratio is calculated by dividing the actual number of readmissions by the expected number and multiplying the figure by 100. It is expressed as a relative risk, where a risk rating of 100 represents the national average. If the trust has a SRR of 100, that means that the number of patients who were readmitted is exactly as would be expected taking into account the standardisation factors. A SRR above 100 means more patients were readmitted than would be expected; one below 100 means that fewer than expected were readmitted.

Control limits

Control limits tell us the range of values which are consistent with random or chance variation. Data points falling within the control limits are consistent with random or chance variation and are said to display ‘common-cause variation’; for data points falling outside the control limits, chance is an unlikely explanation and hence they are said to display ‘special-cause variation’ - that is, where the trust’s rate diverges significantly from the national rate.

Standardised Readmission Ratio- Nephrectomy

Metric

The ratio of the observed number of readmissions to the expected number of readmissions, multiplied by 100.

Numerator

All spells with an emergency readmission within 28 days of discharge.

Readmitting episode- Emergency admissions:

• 21, Emergency - via A&E
• 22, Emergency - via GP
• 23, Emergency - via Bed Bureau
• 24, Emergency - via Out-patient clinic
• 28, Emergency - via other means

Readmission date within 28 days of discharging spell

Procedure Group-

Total excision of kidney- OPCS code: M02

Denominator

Expected number of readmission derived from logistic regression, adjusting for factors to indirectly standardise for differences in case-mix.

Adjustments are made for:

• Sex
• Age on admission (in five year bands up to 90+)
• Admission method (non-elective or elective)
• Socio-economic deprivation quintile of the area of residence of the patient (based on the Carstairs Index)
• Primary procedure
• Co-morbidities (Dr Foster methodology)
• Number of previous emergency admissions
• Year of discharge (financial year)
• Palliative care (whether the patient is being treated in specialty of palliative care)
• Month of admission
• Ethnicity
• Source of admission

Data Source / Time frame

April 2009- March 2010

Basis

Acute Trust

Statistical methods used

Logistic regression

The ratio is calculated by dividing the actual number of readmissions by the expected number and multiplying the figure by 100. It is expressed as a relative risk, where a risk rating of 100 represents the national average. If the trust has a SRR of 100, that means that the number of patients who were readmitted is exactly as would be expected taking into account the standardisation factors. A SRR above 100 means more patients were readmitted than would be expected; one below 100 means that fewer than expected were readmitted.

Control limits

Control limits tell us the range of values which are consistent with random or chance variation. Data points falling within the control limits are consistent with random or chance variation and are said to display ‘common-cause variation’; for data points falling outside the control limits, chance is an unlikely explanation and hence they are said to display ‘special-cause variation’ - that is, where the trust’s rate diverges significantly from the national rate.

TURP reoperation rate

Metric

The rate (expressed as a percentage) of TURP procedures that result in a second operation being performed within a year.

Numerator

All spells that resulted in another TURP procedure being performed within a year of the last TURP procedure (the index procedure).

Procedure Group-

Endoscopic resection of outlet of male bladder: OPCS code- M65

Denominator

Procedure Group-

Endoscopic resection of outlet of male bladder: OPCS code- M65

The episode with the dominant procedure was used in the analysis

Data Source

SUS - CDS

Time frame

Discharge for the index TURP procedure must have occurred between April 2008 and March 2009.

Basis

Acute Trust

Statistical methods used

Crude rate expressed as a percentage.

Your feedback

Please share any concerns or suggestions for improvement that you might have regarding this indicator. In particular, please consider these questions:

• Are there any diagnosis or procedure codes that have been included that you believe should be removed? Please give your reasons
• Are there any diagnosis or procedure codes that have been omitted that you believe should be included? Please give your reasons
• What are the strengths and weaknesses of this metric as an indicator

You can use the feedback box below to submit comments to HSJ. Alternatively, you can email Dr Foster directly at HGconsult2010@drfoster.co.uk. Please submit your response by 31 August 2010.