Abstract
Objectives: NHS England (NHSE) advocates using “reason to reside” (R2R) criteria to generate a binary outcome, which supports discharge related clinical decision making. The proportion of patients without R2R and their rate of discharge are reported daily, by acute hospitals in England. R2R is however, not based upon an inter-operable standardised data model (SDM), nor has its performance been validated against its purpose. We aimed to understand the degree of inter- and intra-centre variation in R2R related metrics reported to NHSE, define a SDM implemented within a single centre Electronic Health Record to generate an eR2R, and evaluate its performance in predicting subsequent discharge.
Design: Retrospective observational cohort study using routinely collected health data.
Setting: 122 NHS Trusts in England for national reporting and an adult acute hospital in England for local reporting.
Participants: 6,602,706 patient-days were analysed using 3 months national data and 1,039,592 patient-days, using 3 years single centre data.
Main outcome measures: Variability in R2R related metrics reported to NHSE. Performance of eR2R in predicting discharge within 24 hours.
Results: There were high levels of intra and inter-centre variability in R2R related metrics (p<0.0001), but not in eR2R. Informedness of eR2R for discharge within 24 hours was low (J-statistic 0.09 – 0.12 across three consecutive years). In those remaining in hospital without eR2R, 61.2% met eR2R criteria on subsequent days (76% within 24 hours), most commonly due to increased NEWS2 (21.9%) or intravenous therapy administration (32.8%).
Conclusions: R2R related performance metrics are highly variable between and within acute Trusts in England. Although case-mix or community care provision may account for some variability, the absence of a SDM is a major barrier to meaningful interpretation of these metrics. The performance of eR2R based on two alternative SDM’s was poor, such that they could not meaningfully contribute to clinical decision making or evaluation of performance.
Design: Retrospective observational cohort study using routinely collected health data.
Setting: 122 NHS Trusts in England for national reporting and an adult acute hospital in England for local reporting.
Participants: 6,602,706 patient-days were analysed using 3 months national data and 1,039,592 patient-days, using 3 years single centre data.
Main outcome measures: Variability in R2R related metrics reported to NHSE. Performance of eR2R in predicting discharge within 24 hours.
Results: There were high levels of intra and inter-centre variability in R2R related metrics (p<0.0001), but not in eR2R. Informedness of eR2R for discharge within 24 hours was low (J-statistic 0.09 – 0.12 across three consecutive years). In those remaining in hospital without eR2R, 61.2% met eR2R criteria on subsequent days (76% within 24 hours), most commonly due to increased NEWS2 (21.9%) or intravenous therapy administration (32.8%).
Conclusions: R2R related performance metrics are highly variable between and within acute Trusts in England. Although case-mix or community care provision may account for some variability, the absence of a SDM is a major barrier to meaningful interpretation of these metrics. The performance of eR2R based on two alternative SDM’s was poor, such that they could not meaningfully contribute to clinical decision making or evaluation of performance.
| Original language | English |
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| Publisher | medRxiv |
| DOIs | |
| Publication status | Published - 20 Apr 2022 |