This is the second publication of adult critical care data, which forms part of Hospital Episode Statistics (HES) and is collected as part of the Critical Care Minimum Data Set (CCMDS). It covers critical care periods ending between 1 April 2009 and 31 March 2010, and draws on records submitted by providers as an attachment to the inpatient record. During the period covered by this report, not all NHS trusts with critical care capacity have completed data submissions, so data quality and coverage is variable in some cases. Publishing the HES critical care data as experimental statistics allows for discussion, analysis and promotion of the dataset, which in turn should lead to improved coverage and data quality.

Monthly data on critical care bed use and cancelled urgent operations Source agency: NHS England Designation: Official Statistics not designated as National Statistics Language: English Alternative title: Critical care bed capacity and cancelled operations: monthly situation reports

This is the third publication of adult critical care data, which forms part of Hospital Episode Statistics (HES) and is collected as part of the Critical Care Minimum Data Set (CCMDS). It covers critical care periods ending between 1 April 2010 and 31 March 2011, and draws on records submitted by providers as an attachment to the inpatient record. During the period covered by this report, not all NHS trusts with critical care capacity have completed data submissions, so data quality and coverage is variable in some cases. Publishing the HES critical care data as experimental statistics allows for discussion, analysis and promotion of the dataset, which in turn should lead to improved coverage and data quality.

The number of hospital beds in the United Kingdom has undergone a decline since the year 2000. Whereas in 2000, there were around 240 thousand beds in the UK, by 2020 this figure was approximately 163 thousand. This means over this period there were over 80 thousand fewer hospital beds in the UK. However in the recent years since 2020, the number of hospital beds have been increasing, the first time in the recorded time period.

Fewer beds but admissions are still high

There were almost 16.4 million admissions to hospital between April 2022 to March 2023 in England. The number of admissions has recovered somewhat since the drop in year 2020/21. The busiest hospital trust in England by admissions in the year 2022/23 was the University Hospitals Birmingham Foundation Trust with over 333 thousand admissions. The average length of stay in hospitals in the UK in 2021 for acute care was seven days.

Accident and Emergency

In the first quarter of 2023/24, A&E in England received around 6.5 million attendees. The number of attendances has been creeping upwards since 2012. Around 2.4 percent of people attending A&E in the last year were diagnosed with an upper respiratory condition, followed by 1.8 percent with a lower respiratory tract infection.

Ventilatory strategies and outcomes for patients acutely admitted to hospital

Dataset 14.0 Version 1.0 15.2.2021

Background. Acute respiratory failure is commonly encountered in the emergency department (ED). Early treatment can have positive effects on long-term outcome. Non-invasive ventilation is commonly used for patients with respiratory failure during acute exacerbations of chronic obstructive lung disease and congestive heart failure. For other patients, including neuromuscular dysfunction, mechanical ventilation may be needed. For refractory hypoxemia, new rescue therapies have emerged to help improve the oxygenation, and in some cases mortality. This dataset summarises the demography, admitting complaint, serial physiology, treatments and ventilatory strategies in patients admitted with hypoxaemia. Management options and rescue therapies including extracorporeal membrane oxygenation are included.

PIONEER geography The West Midlands (WM) has a population of 5.9 million & includes a diverse ethnic & socio-economic mix. There is a higher than average percentage of minority ethnic groups. WM has a large number of elderly residents but is the youngest population in the UK. Each day >100,000 people are treated in hospital, see their GP or are cared for by the NHS.

EHR. University Hospitals Birmingham NHS Foundation Trust (UHB) is one of the largest NHS Trusts in England, providing direct acute services & specialist care across four hospital sites, with 2.2 million patient episodes per year, 2750 beds & 100 ITU beds. ITU capacity increased to 250 beds during the COVID pandemic. UHB runs a fully electronic healthcare record (EHR) (PICS; Birmingham Systems), a shared primary & secondary care record (Your Care Connected) & a patient portal “My Health”. The electronic record captures ventilatory parameters.

Scope: All hospitalised patients with hypoxaemia requiring ventilatory support from 2000 onwards. The dataset includes highly granular patient demographics & co-morbidities taken from ICD-10 & SNOMED-CT codes. Serial, structured data pertaining to care process (timings, staff grades, specialty review, wards), severity, ventilatory requirements, acuity, all physiology readings (pulse, blood pressure, respiratory rate, oxygen saturations), all blood results, microbiology, all prescribed & administered treatments (fluids, antibiotics, inotropes, vasopressors, organ support), all outcomes.

Available supplementary data: Synthetic data. Post discharge care contacts.

Available supplementary support: Analytics, Model build, validation & refinement; A.I.; Data partner support for ETL (extract, transform & load) process, Clinical expertise, Patient & end-user access, Purchaser access, Regulatory requirements, Data-driven trials, “fast screen” services.

The number of admissions has increased year-on-year from 2000 to 2020. Due to the COVID-19 pandemic, hospital admission dropped in 2020/21. In 2023/24 there were around 17.6 million admissions* to NHS hospitals in England, showing that admission numbers have reached and exceeded pre-pandemic levels.

During the financial year 2022/23, the busiest hospital provider in England was the University Hospitals Birmingham Foundation Trust with over 333 thousand admissions. This trust encompasses four hospitals in the Birmingham area, one of the largest urban areas in England. The second busiest trust this year was the Manchester University NHS Foundation Trust with approximately 298 thousand admissions.

Accident and emergency admissions

From April to June 2023, there were around 6.5 million accident and emergency (A&E) attendees (including at A&E departments not in hospitals) in England. After the drop in A&E attendances during the COVID-pandemic, numbers have risen again to previous levels, with a trend towards an increasing number of individuals seeking emergency care. Over three percent of A&E attendees in England in 2022/23 were first diagnosed with a sprained ankle, knee, wrist, or foot, and over four percent were diagnosed with a respiratory infection. Furthermore, 7.4 percent were found to have ‘no abnormality detected’ which could be detrimental to a service that is already stretched.

Waiting too long

Over the last few years in the A&E department, the NHS has been falling behind the target that 95 percent of patients should be seen within four hours of arrival. The last time this target was reached was back in July 2015. Not just the A&E department, but other services also require lengthy waits. It is no wonder that the majority of respondents surveyed were fairly or very dissatisfied with the length of wait for many aspects of NHS care. Moreover, in general, levels of satisfaction with the way NHS runs is at an all time low.

Background

Early warning systems (EWS) are bedside tools used to assess basic physiological parameters to identify patients with potential or established critical illness. Evidence suggests that they may predict risk of intensive care admission, death and length of hospital stay. In 2017, the Royal College of Physicians (RCP) published an updated National Early Warning Score, referred to as NEWS2, based upon six physiological parameters (heart rate, blood pressure, respiratory rate, peripheral oxygen saturations, temperature and level of consciousness). It is associated with specific clinical response recommendations in which a step change occurs at a threshold NEWS2 score >5, requiring an urgent clinical response no matter what the presenting complaint or condition.

PIONEER geography: The West Midlands (WM) has a population of 5.9 million and includes a diverse ethnic and socio-economic mix.

EHR. UHB is one of the largest NHS Trusts in England, providing direct acute services and specialist care across four hospital sites, with 2.2 million patient episodes per year, 2750 beds and an expanded 250 ITU bed capacity during COVID. UHB runs a fully electronic healthcare record (EHR) (PICS; Birmingham Systems), a shared primary and secondary care record (Your Care Connected) and a patient portal “My Health”.

Scope: Serial NEWS2 scores of acutely unwell patients recorded during their hospital stay with each individual component of NEWS2 reported. Longitudinal and individually linked, so that the preceding and subsequent health journey can be mapped and healthcare utilisation prior to and after admission understood. The dataset includes highly granular patient demographics, co-morbidities taken from ICD-10 and SNOMED-CT codes. Serial, structured data pertaining to process of care (timings, admissions), presenting complaint, physiology readings (e.g. heart rate, blood pressure, respiratory rate, NEWS2 score and oxygen saturations), Lab analysis results (Alanine Transferase, albumin, Hb, Creatine Kinase, White Blood Cells and others), microbiology results, medications and all outcomes.

Available supplementary data: Matched controls; ambulance, OMOP data, synthetic data.

Available supplementary support: Analytics, Model build, validation and refinement; A.I.; Data partner support for ETL (extract, transform and load) process, Clinical expertise, Patient and end-user access, Purchaser access, Regulatory requirements, Data-driven trials, “fast screen” services.