Emergency Department Weekly Activity and Waiting Times in Scotland: Week ending 19/04/2015

3. Background Information

Official Statistics on emergency activity and waiting times are published from two sources - a weekly report published by the Scottish Government and a monthly report produced by ISD. ISD is part of NHS National Services Scotland and provides health information, health intelligence and statistical services.

Scottish Government: Weekly Report

This report is produced by Scottish Government statisticians and is based on aggregate statistics submitted by NHS Boards direct to the Scottish Government. It reports on activity in the 32 Emergency Departments that provide a 24 hour emergency medicine consultant led service (as identified by ISD).

Those sites collectively accounted for 83% of all accident and emergency attendances in Scotland during 2014. Caution should be taken in the interpretation of NHS Board level activity as the proportion of all activity accounted for by the 32 Emergency Departments varies by NHS Board (see table below).

Percentage of A&E Activity taking place within Emergency Departments (2014)

NHS Board	Percentage of A&E Activity taking place within Emergency Departments: 2014
NHS Ayrshire and Arran	96%
NHS Borders	94%
NHS Dumfries and Galloway	98%
NHS Fife	72%
NHS Forth Valley	81%
NHS Grampian	72%
NHS Greater Glasgow and Clyde	88%
NHS Highland	54%
NHS Lanarkshire	99%
NHS Lothian	84%
NHS Orkney	100%
NHS Shetland	100%
NHS Tayside	65%
NHS Western Isles	80%
NHSScotland	83%

Source: ISD, A&E Datamart (Jan-Dec 2014)

Following NHS Board submission of statistics each week to Scottish Government, basic quality assurance and data validation is carried out by statisticians. Any queries concerning accuracy or corrections are raised with the relevant NHS Board before publication one week later.

Activity and waiting times for Scotland's MIUs, small hospitals and health centres in rural areas that carry out emergency related activity and are GP or nurse led are excluded from this report. Statisticians will take forward work to investigate how this activity can be incorporated into future reports. Users will be kept informed of developments in this area.

Given the current exclusion of those units from the weekly report, users are advised to refer to ISD's monthly report when comparing national waiting times against the 4 hour Accident and Emergency waiting time Standard.

A list of all sites providing emergency care and their classification is available from ISD in the NHSScotland Accident and Emergency Sites spreadsheet:

http://www.isdscotland.org/Health-Topics/Emergency-Care/Publications/data-tables.asp?id=1383#1383

The purpose of this report is to provide provisional weekly information on activity and waiting times in Emergency Departments, to Official Statistics standards, as early as possible.

Users are advised to view these statistics as providing a useful insight on activity levels, which when taken together with ISD's monthly report, provide a balanced package of timely and comprehensive statistics.

ISD: Monthly Report

The monthly National Statistics report is produced by analysts in ISD and is based on patient records being extracted from NHS Board systems and submitted to the A&E Datamart for the vast majority of A&E sites in Scotland (a small number of MIUs and other facilities provide an aggregate return).

All sites in Scotland that provide accident and emergency care are included and there is more time available for quality assurance and data validation exercises before publication. Statistics are available from July 2007 onwards.

The latest published monthly release is available at:

http://www.isdscotland.org/Health-Topics/Emergency-Care/

Comparison of Weekly and Monthly Data

In order to confirm the reliability of statistics used in the Scottish Government weekly report, Scottish Government statisticians compared the weekly data submitted by NHS Boards for the 32 Emergency Departments with the equivalent weekly data from ISD's A&E datamart. The two sets of figures were almost identical, which gives confidence that the weekly statistics are of sufficient quality to be published.

The exercise to compare weekly waiting times from both sources of statistics is available at the link below. This analysis will be continually refreshed going forward, as part of the ongoing quality assurance of the information submitted to Scottish Government by NHS Boards.

http://www.gov.scot/Topics/Statistics/Browse/Health/Publications/AEweeklyIntro

Comparison with other United Kingdom Countries

Country comparisons should be made with some caution as each country's statistics are based on separate collection systems with their own definitions for the facilities that provide Accident and Emergency care.

Like Scotland, weekly statistics on Accident and Emergency activity and waiting times are also published in England. This is based on activity across different types of department. The Type 1 Department 'Major A&E' includes those departments which provide a consultant led 24 hour service with full resuscitation facilities and designated accommodation for the reception of accident and emergency patients.

http://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/

Waiting Times for Type 1 Departments in England are the closest comparator to the 32 Scottish Emergency Departments included in this weekly report. Over the week ending Sunday the 19^th April, the proportion of Type 1 attendances in England that spent less than 4 hours from arrival to admission, transfer or discharge was 89.8%. Information is not published for the number of patients spending over 8 and 12 hours in the Department.

Monthly statistics are available on Accident and Emergency activity and waiting times in Wales and Northern Ireland. As such the closest comparison with Scotland should use the ISD monthly report.

http://wales.gov.uk/statistics-and-research/time-spent-nhs-accident-emergency-departments/?lang=en

http://www.dhsspsni.gov.uk/index/statistics/ecwt-q3-october-december_2014.pdf

The closest comparator in Wales to the 32 Emergency Departments in Scotland are the 'Major A&E Departments'. These are defined as a consultant led service with appropriate resuscitation facilities and designated accommodation for the reception of accident and emergency patients. These departments must provide the resuscitation, assessment and treatment of acute illness and injury in patients of all ages, and services must be available continuously 24 hours a day. Information is published on 4 hour, 8 hour and 12 hour waits.

The closest comparator in Northern Ireland to the 32 Emergency Departments in Scotland are the

'Type 1 Departments'. These are consultant-led services with designated accommodation for the reception of emergency care patients, providing both emergency medicine and emergency surgical services on a round the clock basis. Information is published on 4 hour and 12 hour waits.