Improving Urgent and unscheduled care
Unscheduled Care (UC) services provide substantial health benefits, but increasing demand is leading to unsustainable pressure on these services and the need for increased funding or new models of care.
In the English National Health Service (NHS) in 2012-13 there were:
18.3 million attendances at major Emergency Departments (ED), single specialty EDs, walkin centres and minor injury units, at a cost of £2.1 billion.
5.3 million emergency hospital admissions, at a cost of £12.5 billion.
7 million ambulance service journeys and approximately 24 million calls to NHS urgent and emergency care telephone services.
Failure of the urgent and emergency care system to manage increasing demand causes substantial public concern and political impact. Delays in ambulance response or Emergency Department (ED) assessment leads to worse patient outcomes. ED crowding is internationally recognised and is shown to be associated with avoidable mortality.
Of particular interest are the most vulnerable groups within the population who typically tend to be more frequent users of unscheduled care due to living with multiple long term conditions and the consequences of ageing. These patients often have healthcare needs which have not been met resulting in them tipping into unscheduled care for their routine as well as urgent healthcare needs, or entering the revolving door of hospital admission – readmission. Many patients are extremely complex and not only have physical health, but mental health needs and social care requirements. They are often the hardest to reach patient groups for participation in clinical trials, and as such developing cutting edge solutions to their healthcare needs is not prioritised.
Establishing a linked dataset
The CUREd (urgent and emergency care) dataset covers a population of 5.5 million (Yorkshire & Humber region, UK) from 2011, and links all patient episode data from 999/111 call to emergency department attendance and acute hospital admission and readmission (14 acute trusts) for adults and children. There are over 15 million episodes of care in the dataset.
Approvals for the dataset were obtained through NHS HRA and section 251 CAG approval, such that data is fully identifiable for linkage purposes and subsequently deidentified for research. Patient inclusion is on an opt-out basis. Approval for the dataset by the HRA as a research database means the data is research-ready and available for multiple use purposes and wider linkage with related datasets. Examples of further linkage currently being undertaken include linking mental health trust data and also hospice data (for end of life care patients).