Questions a PCT should ask
Variation in the number of emergency admissions discharged on the same day is inexplicably high. As the first chart shows, there is up to four-fold variation in the rate of such admissions, even after PCT population size and its level of deprivation are taken into account. After the length of stay reduction is applied, these spells cost a typical PCT, with 8,000 such admissions, some £4 million per year.
Consequently, PCTs should investigate and understand their relative position. To help with a more detailed examination, we have developed an analytical tool which local NHS organisations can use to examine the position trust by trust, down to HRG level if required.
Unlike longer emergency spells, the variation in rate of short stay emergencies exhibits relatively little relationship with deprivation. Remarkably, none of the remaining variation is explained by age.
Clearly, if it were possible to keep these patients away from hospital by providing better primary care, that would be desirable. However we found no evidence of a link between GP access and these rates. Evidence that short stay inpatient admissions replace A&E attendances would be of concern from a financial point of view. On the other hand, any suggestion that such patients from your PCT would have stayed longer in other hospitals might be of concern from a clinical perspective. Our analysis uncovers no clear evidence suggesting either hypothesis so the remarkable level of variation remains unexplained.
When you have looked at your overall performance on zero length of stay admissions, you will probably then want to look in more depth at indicators at your local provider trusts. Our newly released PbR benchmarker, available throughout the NHS, helps you to do that (along with much else besides).
In the last chart, it's no coincidence that trust Y exhibits a remarkably high percentage of zero length spells in general medicine - trust Y provides most of PCT X's (first chart) acute healthcare. Do you know for certain that you aren't PCT X or trust Y?
Access our PbR Benchmarker (external link) system.