Standard Cost Model: Neonatal Critical Care Minimum Dataset
NHS Information Centre for Health and
Social Care
Standard Cost Model - Data Collection Review
of
Neonatal Critical Care Minimum Datasets
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Standard Cost Model: Neonatal Critical Care Minimum Dataset
1. Standard Cost Model
In response to a request from the Cabinet Office Better Regulation Executive,
the Information Centre for health and social care (IC) has adopted the
Standard Cost Model (SCM) methodology as a way of measuring the burden
imposed on the NHS, by the public sector, through the collection of centrally
required data.
2. Coverage
This report covers the ROCR approved data collection for Neonatal Critical
Care Minimum Dataset (NCCMD)
ROCR/OR/0184/FT6/001
Neonatal Critical Care Minimum Dataset
(NCCMD)
Neonatal Critical Care Minimum Dataset data is collected monthly.
3. Introduction
Neonatal Critical Care Minimum Dataset is designed for neonatal care
services to inform HRG’s and PbR.. The information collected is shown in
Appendix 11.
Data is required from all Acute Trusts (Foundation and Non Foundation)
which provide neonatal care services. The Data is collected by the Health and
Social Care Information Centre as part of the Admitted Patient Care
Commissioning Dataset. Normally, data is gathered in local IT systems, and
flowed through the Secondary Uses Service.
4. Approach
This exercise was undertaken across a sample of Acute Trusts (Foundation
and Non Foundation), and PCTs, of differing sizes and localities. An overview
of the collection was obtained from Health and Social Care Information Centre
ROCR approval (September 2008).
Two different questionnaires were issued:
1) An Overview - to be completed by a manager in each organisation who had
an overview of the whole process and
2) Individual - to be completed by individuals involved in the collection
process.
In addition to the questionnaires one PCT was visited.
Organisations were asked to provide burden and feed back on the whole end
to end process, including collecting, validation, sign off and submission of
data.
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Standard Cost Model: Neonatal Critical Care Minimum Dataset
The overview questionnaire asked 3 main questions:

Within your organisation what is the total time taken by colleagues in
each occupational group to complete the data request for a typical
week?

What problems, if any, have you encountered when completing this
data request?

Have you any other feedback that you would like to give about this
collection?
5. Results
Table 1 illustrates the number of Trusts from which responses to the
questionnaires were received.
Table 1
Type of Trust
Number
contacted
Number of
responses
% response
rate
Acute Trusts
(Foundation and Non
Foundation)
43
2
5
A number of staff groups are involved in the NCCMD collection as shown in
Table 2 below. Based on this sample, on average Acute Trusts worked on
the return 18 days per annum (110/37.5/2*12). This relates exactly to the
burden given in the ROCR proposal.
Table 2
Occupational Group
Number of 0rg
Senior manager
Manager
Consultants
Hospital Doctors
Nurses and Midwives
Clerical & Administrative
Healthcare Assistants and
Other
Total
Average
1
1
1
1
1
1
1
2
Time Spent
(Hours per
month)
5
5
16
14
40
20
10
110
1.5 dys
The percentage time spent on the collection process, based on one response
to the surveys, is seen below in Table 3.
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Standard Cost Model: Neonatal Critical Care Minimum Dataset
Table 3
Gathering and submitting the Data
% Time Spent by responding
Organisations (Average)
50
30
10
10
Collect
Collate
Validate
Submit
The total burden for NCCMD per year, based on the ROCR proposal, is 1,460
person days or 7.3 years covering 98 Acute Trusts (non Foundation) and
Acute Foundation Trusts
The burden indicated in the ROCR proposal roughly equates to that of the
respondents and the Trust visited.
6. Issues
In response to the question “What problems, if any, have you encountered
when completing this data request?” The following responses, in Table 4,
were received.
Table 4
Response
Need to collect data from
different sources
Will need to wait for data that
is available at different times
Available data does not match
the data requested
Unclear questions / guidance
Other
Responding
Organisations
1
1
-
7. Additional comments:

This information is collated on Neonatal.net and therefore the
information is also used the National Neonatal Audit as well as the
basis for our admission sheets and discharge letters; in response to
the question ‘Is the data collected useful to you Trusts’.

A significant proportion of the data was difficult to obtain as we don’t
keep in the format requested. We were not able to save the dataset .

Could the information requested not be downloaded from SEND as it
was extremely time consuming with short deadline within our current
workload? We are constantly being asked to provide data in a different
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format. It is not clear how this data is used and the impact on individual
units. A significant portion of the detail had to be manually collected.

Data is valuable. It is used example for staffing, skills mix and number
of ventilators required
8. Case Study
What is collected?
Neonatal return is provided on a monthly basis. Information is gathered by
bedside monitoring and based on daily nursing tasks.
System:
Information is collected at the end of the month [on a form]. Nurses enter
data daily and form is completed in about 5 minutes. Data entry takes place
on one day per month then emailed to finance. Data is collected manually
from suppliers.
Problems:
Process is duplicated by nurses and finance. Forms collected from nurses
are sent to IT who then input to Excel. Data is not flowing through SUS.
Solutions:
Could use handheld machines which send the data directly to IT to process.
Data could be obtained from PAS.
Other Comments:
Neonatal collection is more manageable that Paediatric dataset. Paediatric
has a rapid turnover. Information is based on daily basis. A bed can be used
4 times a day. Data is loosed during busy period. Tracking patients
afterwards is difficult. Criteria set by DH for high dependency is different to
that of local users. NCCMD data is valuable. It is used example for staffing,
skills mix and number of ventilators required.
See also Appendix II summary of data collection in one organisation.
9. Resources used in carrying out this assessment
IC staff spent around 4 days on this review of the NCCMD collections. The
time covered tasks such as:






Designing and issuing questionnaires
Corresponding with Trusts
Meetings and travel time
Meeting with the sponsor
Record keeping
Report writing.
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Trusts responding took an average of 15 minutes each to complete the SCM
questionnaire. The IC met with colleagues from one Trust for approximately
one hour.
10. Summary & Recommendations
Data from the participating organisations indicates that the end to end process
creates a significant burden to Trusts.
It was clear from both the meeting and the surveys that Trusts find the
NCCMD process burdensome but valuable.
The NCCMD return is required monthly but needs Trusts to collect data on a
daily basis.
However, based on the low response it is difficult to make definite
conclusions.
The initial recommendation is that:



Changes that should be considered.
The possibility of other data source could be explored.
More consideration could be given to the method of collection
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Standard Cost Model: Neonatal Critical Care Minimum Dataset
Appendix 1
The scope of the Neonatal Critical Care Minimum Data Set is:
a)
b)
01
02
04
05
06
07
08
09
10
11
12
13
14
15
16
22
23
24
25
26
27
28
29
All PATIENTS on a WARD with a CRITICAL CARE UNIT
FUNCTION Neonatal Intensive Care Unit regardless of care being
delivered.
All PATIENTS (excluding Mothers) on a WARD with a CRITICAL
CARE UNIT FUNCTION Facility for Babies on a Neonatal
Transitional Care Ward or Facility for Babies on a Maternity Ward
to whom one or more of the following CRITICAL CARE
ACTIVITIES applies for a period greater than 4 hours:
Respiratory support via a tracheal tube
Nasal Continuous Positive Airway Pressure (nCPAP)
Exchange Transfusion
Peritoneal Dialysis
Continuous infusion of inotrope, pulmonary vasodilator or
prostaglandin
Parentral Nutrition
Convulsions
Oxygen Therapy
Neonatal abstinence syndrome
Care of an intra-arterial catheter or chest drain
Dilution Exchange Transfusion
Tracheostomy cared for by nursing staff
Tracheostomy cared for by external carer
Recurrent apnoea
Haemofiltration
Continuous monitoring
Intravenous glucose and electrolyte solutions
Tube-fed
Barrier nursed
Phototherapy
Special monitoring
Observations at regular intervals
Intravenous medication
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Appendix 11
Example of summary data in one organisation
SUMMARY OF NEONATAL CRITICAL CARE ACTIVITY - APRIL 2009 TO MARCH 2010
INTERVENTION
APRIL
MAY
TOTAL
PGI
DDH
PGI
DDH
PGI
DDH
NO. OF BABIES ADMITTED TO UNIT
30
35
37
34
67
69
NO. OF BABIES DISCHARGED FROM UNIT
17
24
28
23
45
47
ICU
No. of ICU Babies
7
5
12
9
19
14
No. of ICU Days
106
5
59
60
165
65
Respiratory support via trachael tube
58
5
19
7
77
12
Nasal Continuous Positive Airway Pressure (nCPAP)
49
1
43
11
92
12
Surgery
0
0
0
0
0
0
Exchange Transfusion
0
0
0
0
0
0
Periontoneal Dialysis
0
0
0
0
0
0
0
0
0
2
0
2
169
26
Continuous infusion of inotrope, vasodilator or
prostaglandin
TOTAL ICU BED DAYS
HDU
No. of HDU Babies
9
7
9
12
18
19
No. of HDU Days
48
104
17
63
65
167
Convulsions
0
1
1
9
1
10
38
17
49
70
87
87
Neonatal abstinence syndrome
27
93
35
0
62
93
Care of an intra-arterial catheter or chest drain
22
0
7
2
29
2
Dilution Exchange Transfusion
0
0
0
0
0
0
Tracheostomy cared for by nursing staff
TOTAL HDU BED DAYS
0
0
0
0
0
179
0
192
Parental Nutrition
55
44
15
0
70
44
Tracheostomy cared for by external carer
0
0
0
0
0
0
Recurrent apnoea
0
0
2
11
2
11
Haemofiltration
0
0
0
0
0
0
Oxygen Therapy
SAMPLE
SPECIAL CARE
Carer Resident - Caring for Baby
9
23
5
1
14
24
Continuous monitoring
316
325
209
189
525
514
Intravenous glucose & electrolyte solutions
120
73
69
49
189
122
Tube-fed
401
457
231
122
632
579
Barrier Nursed
17
19
3
0
20
19
Phototherapy
18
3
24
2
42
5
Special Monitoring
172
214
124
163
296
377
Observations at regular intervals
362
428
251
220
613
648
Intravenous medication
137
65
71
61
208
126
No defined critical care activity
TOTAL SPECIAL CARE BED DAYS
TOTAL NUMBER OF INTERVENSIONS
12
4
24
44
1706
1586
1180
965
36
2647
2886
48
2517
2551
TOTAL OCCUPIED BED DAYS
401
457
287
234
688
691
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Source
1
Neonatal Critical Care Minimum Data Set Overview, Change history 3.5 , June
2009, NHS Connecting for Health,
http://www.datadictionary.nhs.uk/data_dictionary/messages/supporting_data_sets/dat
a_sets/neonatal_critical_care_minimum_data_set_fr.asp?shownav=1
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