NHS Care Records Service
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SUS Release 9 – Critical Care
Web Conference Training Presentation
Audio is provided on the following number
Telephone:
Passcode:
0844 335 1194
781 592
Welcome
NHS Care Records Service
Max McLellan, Training Manager SUS & Spine Programme
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Purpose of today‟s session
Overview of Critical Care for R9
Validations
Counting Critical Care days
Generating HRGs
Extracts
Q&A
NHS Care Records Service
Introduction
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Webinar timings – approx. 60 minutes
Questions and answers:
• Email: enquiries@ic.nhs.uk and quote “SUS Webinar”.
• Q&A will be sent out after the Webinar to everyone that
has registered.
Mike Pemberton – SUS PbR R9 Release
Subject Matter Expert
NHS Care Records Service
Critical Care
Overview
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Critical Care for 2011/2012
As in previous years SUS PbR must ensure that the
correct number of Critical Care (CC) days are counted
for each record for input to the grouping process.
Critical Care tariff calculation is on a per day basis and
it is therefore essential that the correct number of valid
days within a Spell are counted and totalled to allow
SUS PbR to assign any future tariff.
NHS Care Records Service
Critical Care
Overview
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For processing and reporting purposes Critical Care
has the following types:
CC Type
ACC - Adult Critical Care
PCC - Children & Young People
NCC - Neonatal / Babies
CCP - Critical Care Period
Critical Care data is carried on CDS types 120, 130
and 140 for Admitted Patient Care (APC) records only.
NHS Care Records Service
Critical Care
Overview Critical Care for 2011/2012
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To ensure that Critical Care days are correctly counted and
available for future tariff SUS PbR will:
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Perform Validations
Allocate Critical Care days to episodes
Perform Spell length of stay (LoS) adjustments
Generate Core HRGs and unbundled Critical Care HRGs
A new Managed Service Critical Care Extract will be available in
-line with RBAC controls. It will be available after the current
Managed Service Extracts at the PBR 2011/12 Reconciliation
and Post-Reconciliation points.
NHS Care Records Service
Critical Care
Validations Resulting in Exclusions
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Each Critical Care period is validated to ensure that the correct
number of days are counted for grouping and future tariffing.
To achieve this SUS PbR looks at each episode within a Spell and
excludes certain Critical Care periods from further Critical Care
processing (listed below).
SUS PbR will apply a Critical Care indicator to highlight the reason for
its exclusion which is included in the Critical Care extract.
Reason for Exclusion
Missing or additional daily PCC/NCC records
Critical Care Indicator
1
Critical Care start date is less than the spell
admission date or the Critical Care discharge
2
date is greater than the Spell discharge date
NHS Care Records Service
Critical Care
Validations
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Reason for Exclusion
Critical Care Indicator
Critical Care start date is NULL and
Critical Care discharge Is not NULL
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Invalid Critical Care combinations
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Valid Critical Care Combinations - 5 valid combinations:
ACC alone
ACC + PCC
PCC alone
PCC + NCC
NCC alone
Critical Care
Validations
NHS Care Records Service
Reason for Exclusion
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Critical Care Indicator
NCC data group inconsistent with
patient age
5
NCC/PCC daily records are outside
the Critical Care period
6
Example of NCC data group inconsistent with patient age
If a Spell has any Neonatal Critical Care (NCC) data and the
Critical Care Patient Type is not „CHI‟ on episodes, the system
will not perform any Critical Care processing and the Spell and
the episode will be allocated the Critical Care indicator 5.
Patient Type has 4 values:
Child (0-18), Adult (19 -130), Error (131-998) and Other (999 999)
Once identified the value found for Critical Care Patient Type will
be included in the Critical Care extract.
NHS Care Records Service
Critical Care
Validations
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Reason for Exclusion
Critical Care Indicator
Overlapping Critical Care periods
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Episode start date is greater than
Episode end date
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There are 5 rules governing overlapping Critical Care periods.
1. Exact match where duration is 1 day
2. Multiple exact matches where duration is greater than 1 day
3. Overlap of Start and Discharge date
4. Overlap where duration is greater than 1 day
5. Multiple overlaps of 1 day
NHS Care Records Service
Validations
Overlapping Critical Care Period
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Rule 1 – Exact match where the duration of Critical Care is 1 day
Valid
When two periods of Critical Care lasting just 1 day are submitted with the
exact same start date and end date e.g. 24th April 2011, this is classed as a
valid overlap and processing will continue with only 1 day counted and
processed for grouping with 2 days counted for tariffing.
CCP
Date
CCP1
24th Apr
CCP2
24th Apr
Not Valid
When three or more periods of Critical Care lasting just 1 day are submitted
with the exact same start date and end date e.g. 24th April 2011, this not a
valid overlap and processing will stop.
CCP
Date
CCP1
24th Apr
CCP2
24th Apr
CCP3
24th Apr
NHS Care Records Service
Validations
Overlapping Critical Care Periods
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Rule 2 – Multiple exact matches where duration is greater
than 1 day
Valid
Where two or more (up to 9) periods of Critical Care lasting more than 1 day
are submitted with the exact same start date and end date e.g. 22nd April to
24th April 2011, this is classed as a valid overlap.
Only one of the Critical Care periods will be used for allocating days to
episode, Spell and grouping. The period used is defined as the „Last Sent‟.
„Last Sent‟ is the Critical Care period carried on the Latest Episode and uses
the SUS processing date to determine this. If all elements appear on the
same episode then the first Critical Care period will be used.
CCP
Date
Date
Date
CCP1
22 Apr
23 Apr
24 Apr
CCP2
22 Apr
23 Apr
24 Apr
CCP3
22 Apr
23 Apr
24 Apr
NHS Care Records Service
Validations
Overlapping Critical Care Period
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Rule 3. Overlap of Start and Discharge date
Valid
Where a Critical Care period has a discharge date that is the
same as the start date of another Critical Care period, this is
deemed valid and Critical Care processing will continue.
CCP1
1
2
CCP2
3
3
4
NHS Care Records Service
Validations
Overlapping Critical Care Period
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Rule 4. Overlap where duration is greater than 1 day
Not valid
Where a Critical Care period overlaps another Critical Care
period in the Spell by more than 1 day and is not an exact match
then ALL Critical Care processing is stopped and no grouping is
performed or adjustment made to length of stay.
CCP1
1
CCP2
2
3
2
3
Rule 5. Multiple overlaps of 1 day
Where a Spell has more than two Critical Care periods with a
duration of 1 day then ALL Critical Care processing is stopped
and no Grouping is performed or adjustment made to length of
stay.
NHS Care Records Service
Critical Care
Validations
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Reason for Exclusion
Critical Care Indicator
Critical Care start date is NULL and
Critical Care discharge date is NULL
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Critical Care start date is not NULL and
Critical Care discharge date is NULL
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Critical Care start date is greater than
Critical Care discharge date
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NHS Care Records Service
Critical Care
Counting Critical Care Days
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For each Spell, the total number of ACC/NCC/PCC Critical Care days
are calculated by adding the number of distinct Critical Care days
together for each of the episodes within that Spell. To ensure this is
correct there are a number of rules that SUS PbR follows to assign
Critical Care days to an individual episode.
SUS will:
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Order all Critical Care periods earliest to latest.
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Where a Critical Care period spans the boundaries of two episodes in a
Spell, SUS PbR will allocate the Critical Care day to the episode where
the episode start date matches the Critical Care start date.
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SUS PbR will then, for each episode, sum the number of distinct critical
days allocated by type (ACC, NCC, PCC) and calculate the total
Critical Care days. Total CC days inform LoS adjustment and tariff
calculation.
•
The total of the CC days will be captured in the new Critical Care
extract attributes Length of Stay Critical Care days and Tariff Critical
Care days.
NHS Care Records Service
Critical Care
Counting Critical Care Days
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Critical Care Extract - Live
NHS Care Records Service
Critical Care
Counting Critical Care Days
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Multiple episodes
In the case of a multi-episode Spell where the Critical Care
period spans the episode boundary there will be two
episodes that could claim to have the same day belonging
to that episode. The rule to resolve this is as follows;
„Where a day can be allocated to multiple episodes it must
always be allocated to the last episode when ordered on
Episode Start Date‟.
Note: Previously this would have stopped the Critical Care
processing.
NHS Care Records Service
Critical Care
Counting Critical Care Days
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Critical Care days outside of an episode but inside the Spell
boundary
Where Critical Care periods fall inside the Spell boundaries but
do not fall inside the boundaries of episodes, the system will
exclude these periods from Critical Care processing. SUS PbR
will process these days when the missing episodes are received
and a new Spell version is computed.
The Critical Care extract contains an attribute; Excluded
Reason - that differentiates between Critical Care assigned to
included/excluded episode.
• „0‟ indicates that the episode is included
• „1‟ indicates that the episode is excluded
NHS Care Records Service
Counting CC days
Calculating Spell Length of Stay (LoS)
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The Spell Length of Stay (LOS) calculation does not change from 2010/11 PBR. It remains
as: The SUM of the included Episode LOS minus CC Days calculated for each episode.
EVENT
START
END
LOS
Episode CC Days
Epi1
01/04
07/04
6
4
Epi2
07/04
13/05
6
4
CC1
03/04
10/04
8
Spell S1
01/04
13/04
12
SpellCC Days
8
In this example the Critical Care period has 8 DISTINCT days 03/04 to 10/04.
The Spell length of stay is the sum of each included episode length of stay adjusted for CC
days.
Note: As 07/04 falls in each episode the CC day will always be allocated to the second
episode.
The CC Days for grouping is therefore Epi1 = 4 and Epi2 = 4
Generation of HRGs
NHS Care Records Service
Grouper Input
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The current system supports 3 types of Critical Care input:
Adult Critical Care (ACC) – a single record per period with
up to 9 records per episode. There will be no related CCP
type records in the extract.
Neonatal Critical Care (NCC) – must have at least 1 CCP
entry. Can have up to 9 CCP records per episode.
Paediatric Critical Care (PCC) must have at least 1 CCP
entry. Can have up to 9 CCP records per episode.
Generation of HRGs
NHS Care Records Service
HRG Generation
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The ACC records produce an HRG for each of the 9 potential
Critical Care Period inputs.
As each input can contain more than a single day of Critical
Care it is not possible to generate a separate HRG for each
day of the ACC Critical Care period. Therefore any future tariff
will be calculated by multiplying the unit tariff by the number of
CC days calculated previously.
NCC and PCC are daily records and will produce an HRG for
each day within a Critical Care period.
There can be up to 999 of these per period. Each of these are
calculated individually and the sum of the tariff allocated to the
Spell.
NB: Daily records allocated UZ01Z will not attract a tariff.
NHS Care Records Service
Generation of HRGs
Stepping Down
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Stepping Down
Where two Critical Care periods overlap by 1 day i.e. the
discharge date for the one Critical Care period equals the
start date for the subsequent period, the system will apply
the following to ensure correct counting and allocation of
the overlapping day:
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Count the day once for the purposes of allocating Critical
Care days to episodes.
Count the day once for adjusting spell LoS.
Allocate the day to both Critical Care periods for the
purposes of generating HRGs.
NHS Care Records Service
Generation of HRGs
Stepping Down
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SUS PbR will:
Where two episodes have an END and START date of the same
calendar Day, then the daily record will produce an HRG for the
same day for each episode and the tariff will be applied to both.
Where the Critical Care period is an ACC and since there is only
one HRG per Critical Care period, each episode for tariff
purposes is treated independently, therefore the discharge date
of the first episode is paid for episode 1 and the admission date
of the second episode is paid in episode 2.
Therefore the same day is paid twice.
NHS Care Records Service
New Managed Service
Extract
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Critical Care Extract - Live
Q&A
NHS Care Records Service
Max McLellan, Training Manager SUS & Spine Programme
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•
Questions and answers
•
Email: enquiries@ic.nhs.uk and quote “SUS
Webinar”.
•
Q&A will be sent out after the Webinar to
everyone that has registered.
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NHS Care Records Service
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NHS Care Records Service