Information Services Division
Multiple and All Emergency Admissions
Interpretation Notes
All Emergency Admissions
An emergency admission is defined as being a new continuous spell of care
in hospital where the patient was admitted as an emergency.
The total number of emergency admissions is then calculated by counting the
number of continuous spells in hospital within a financial year.
From December 2009, all ISD National Statistics publications for Multiple and
All Emergency Admissions and Bed Days data will be based on the date of
discharge rather than the date of admission. This change has been made in
order to provide more accurate, relevant and complete data, particularly in
relation to bed days information. Displaying the data by date of discharge
means that more complete stays are included in the analysis. An emergency
admission is only counted if the date of discharge associated with the spell of
hospital care is with the financial years specified.
The date of discharge for a continuous spell of hospital care is derived from
the last episode of the spell of treatment.

If a patient was admitted as an emergency on 1st December 2006 and
discharged on or before 31st March 2007, the patient would be counted as
an emergency admission for the financial year ending 31st March 2007. If
a patient was admitted as an emergency on 1st March 2007 and
discharged on 1st May 2007, this would count as an emergency admission
for the financial year ending 31st March 2008.
Information Services Division
Multiple Emergency Admissions
If a patient has more than one unplanned continuous spell of treatment in
hospital in a year, this is defined as a multiple emergency admission for that
patient.
If one patient has 2 emergency continuous spells of care in hospital in a year
and another patient has 10 emergency spells of hospital care in the same
year, then they would simply count as 2 patients with multiple emergency
admissions.

If a patient was admitted as an emergency on 1st December 2007 and
discharged on 20th December 2007, admitted again on 1st February 2008
and discharged on 15th February 2008, this patient would count as one
patient with multiple emergency admissions for the financial year ending
31st March 2008.

If a patient was admitted as an emergency on 1st December 2007 and
discharged on 20th December 2007, admitted again on 1st February 2008
and discharged on 15th February 2008, and then admitted on 1st March
2008 and discharged on 2nd April 2008 with no further admissions this
patient would count as a patient with multiple emergency admissions (two)
for the financial year ending 31st March 2008 and a single emergency
admission for the financial year ending 31st March 2009.
It is important to note that since information is shown for different
geographical levels of analysis (e.g. NHS Board, Local Authority and
Community Health Partnership) it is likely that the data may show some
inconsistencies, for example, patients who are counted in different CHPs may
only be counted once for the NHS Board.

If a patient had 4 emergency admissions within NHS Lothian but 2 were in
West Lothian CHP and 2 were in Midlothian CHP because the patient
moved house, these would be counted as a patient with a multiple
emergency admission in West Lothian CHP and a patient with a multiple
emergency admission in Midlothian CHP, but only as one patient with a
multiple admission for NHS Lothian.
2
Information Services Division
Bed Days
Occupied bed days are used to quantify the availability and use of beds over
time. These are calculated by counting the number of days between the date
of admission associated with the beginning of a patient's continuous spell of
treatment and the date of discharge associated with the end of the same spell
of treatment.
The date of discharge must lie between 1st April and 31st March of a given
financial year to calculate the number of bed days associated with emergency
admissions in that year.
Only emergency admissions with a length of stay of 365 days or less are
included in the bed days analysis.

If a patient was admitted on 1st June 2006 for an emergency operation for
a Heart Bypass in Cardiac Surgery specialty, and transferred from that
specialty to Rehabilitation Medicine on 1st July 2006, and then
subsequently discharged from Rehabilitation Medicine on 31st July 2006,
this would count as a single emergency admission in the year ending 31st
March 2007. The total number of occupied bed days for this emergency
admission would be calculated from 1st June 2006 to 31st July 2006 (60
days).
Alternatively,

If a patient was admitted on 1st March 2007 for an emergency operation
for a Heart Bypass in Cardiac Surgery specialty, and transferred from that
specialty to Rehabilitation Medicine on 15th March 2007, and then
subsequently discharged from Rehabilitation Medicine on 1st April 2007,
this would count as a single emergency admission in the year ending 31st
March 2008. The total number of occupied bed days for this emergency
admission would be calculated from 1st March 2007 to 1st April 2007 (30
days).
3
Information Services Division
Information Layout
For multiple emergency admissions, information for all geographical
breakdowns (NHS Board, Local Authority, Community Health Partnership) are
now presented as separate tables within a single data file. Each table
contains menus that enable the user to obtain information on numbers of
patients with 1, 2 or 3+ admissions and numbers of bed days, as well as rates
per 100,000 population for various age groups. Data is provided for the last 10
financial years.
Trend information for admission and bed day rates are also displayed in
graphical form, broken down by each geographical area. Specific NHS
Boards/Local Authorities/CHPs of interest can be compared with each other
and also with Scotland. Overall Scotland trends are shown split by age group.
A similar layout is provided for all emergency admissions.
For patients aged 65 years and over, all information for both multiple and all
emergency admissions is now presented in separate tables within a single
data file. Each worksheet in the file contains menus that can be adjusted to
show information on numbers of emergency admissions, numbers of patients
with 1, 2 or 3+ admissions and numbers of bed days, as well as rates per
100,000 population for different geographical areas. Standardised incidence
ratios, see below, are also provided for patients with 2 or more admissions by
NHS Board, CHP and Local Authority, for the last 6 financial years.
Patients aged 65 years and over - standardisation by sex, age
group and deprivation
One of the main determinants in multiple emergency admissions, other than
quality of care, is patient case mix. Factors such as deprivation, age group
and gender are likely to influence numbers of multiple admissions. Thus,
differences in multiple admission rates between areas may be due to
differences in the case mix of patients admitted.
One way of adjusting for these differences in rates is to use standardisation.
Due to small numbers the method chosen for this analysis is indirect
standardisation. This method has been applied to all patients aged 65 and
over.
Indirect standardisation compares actual numbers of emergency admissions
to expected numbers, adjusting for age, sex and deprivation. This produces a
ratio which is called a standardised incidence ratio.
4
Information Services Division
HEAT targets
Patients aged 65 and over
The Scottish Government developed a HEAT target which related to the
number of occupied bed days for patients aged 65 and over who were
admitted as an emergency. The target is defined as follows:
By 2010/11, NHS Boards will reduce the emergency inpatient bed days for
people aged 65 and over, by 10% compared with 2004/05.
With regard to the data analysis for this target, the following definitions are
used:
The published statistics are derived from data collected on discharges from
non-obstetric and non-psychiatric hospitals (SMR01) in Scotland. Data from
the 3 Scottish Dental hospitals (in Dundee, Edinburgh and Glasgow), and the
specialties Special Care Baby Unit and Geriatric Long Stay are excluded.
The basic unit of analysis for these figures is a Continuous Inpatient Stay
(CIS) in hospital. Probability matching methods have been used to link
together individual SMR01 hospitals episodes for each patient, thereby
creating “linked” patient stay histories.
Only emergency admissions are selected and any lengths of stay greater than
365 days have been excluded.
Age of patients has been derived at the mid point of the financial year (i.e. age
on the 1st of October of the year of admission).
The data are based on year of admission. Assessment of performance in
relation to this HEAT target is measured using information based on year of
admission rather than year of discharge
Patients aged 75 and over
The Scottish Government developed a new HEAT target for emergency
admissions to sustain focus on this important aspect of NHS performance.
The amendment to this target sharpens the focus on the subgroup of patients
aged 75 and over who have longer hospital stays and a higher risk of HAI,
delayed discharge and institutional care outcomes.
By 2011/12, NHS Boards will reduce the number of emergency inpatient bed
days for people aged 75 and over, compared with 2010/11.
5
Information Services Division
With regard to the data analysis for this target, the following definitions are
used:
The published statistics are derived from data collected on discharges from
non-obstetric and non-psychiatric hospitals (SMR01) in Scotland. Data from
the 3 Scottish Dental hospitals (in Dundee, Edinburgh and Glasgow), and the
specialties Special Care Baby Unit and Geriatric Long Stay are excluded.
The basic unit of analysis for these figures is a Continuous Inpatient Stay
(CIS) in hospital. Probability matching methods have been used to link
together individual SMR01 hospitals episodes for each patient, thereby
creating “linked” patient stay histories.
Only stays were the patient was admitted as an emergency are included and
all emergency hospital stays of any length are included.
Age of patients is calculated using the date of the emergency admission to
hospital.
Beds days are specifically allocated to the year in which they took place. For
example, if a patient was admitted on 1 March 2008 and discharged on 1 May
2009 a total of 31 days have been assigned to the year ending 31st March
2008, 365 days have been allocated to the year ending 31st March 2009 and
30 days have been allocated to the year ending 31st March 2010.
For any further queries regarding the analysis of emergency admissions data,
please email the Secondary Care Team .
6