These indicators are designed to accompany the SHMI publication. Information on the main condition the patient is in hospital for (the primary diagnosis) is used to calculate the expected number of deaths used in the calculation of the SHMI. A high percentage of records with an invalid primary diagnosis may indicate a data quality problem. A high percentage of records with a primary diagnosis which is a symptom or sign may indicate problems with data quality or timely diagnosis of patients, but may also reflect the case-mix of patients or the service model of the trust (e.g. a high level of admissions to acute admissions wards for assessment and stabilisation). Contextual indicators on the percentage of provider spells with an invalid primary diagnosis and the percentage of provider spells with a primary diagnosis which is a symptom or sign are produced to support the interpretation of the SHMI. Notes: 1. There is a shortfall in the number of records for North Middlesex University Hospital NHS Trust (trust code RAP), Northumbria Healthcare NHS Foundation Trust (trust code RTF), The Rotherham NHS Foundation Trust (trust code RFR), and The Shrewsbury and Telford Hospital NHS Trust (trust code RXW). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 3. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. Information on the main condition the patient is in hospital for (the primary diagnosis) is used to calculate the expected number of deaths used in the calculation of the SHMI. A high percentage of records with an invalid primary diagnosis may indicate a data quality problem. A high percentage of records with a primary diagnosis which is a symptom or sign may indicate problems with data quality or timely diagnosis of patients, but may also reflect the case-mix of patients or the service model of the trust (e.g. a high level of admissions to acute admissions wards for assessment and stabilisation). Contextual indicators on the percentage of provider spells with an invalid primary diagnosis and the percentage of provider spells with a primary diagnosis which is a symptom or sign are produced to support the interpretation of the SHMI. Notes: 1. There is a shortfall in the number of records for East Cheshire NHS Trust (trust code RJN), Mid Cheshire Hospitals NHS Foundation Trust (trust code RBT), and Wirral University Teaching Hospital NHS Foundation Trust (trust code RBL). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 3. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. Information on the main condition the patient is in hospital for (the primary diagnosis) is used to calculate the expected number of deaths used in the calculation of the SHMI. A high percentage of records with an invalid primary diagnosis may indicate a data quality problem. A high percentage of records with a primary diagnosis which is a symptom or sign may indicate problems with data quality or timely diagnosis of patients, but may also reflect the case-mix of patients or the service model of the trust (e.g. a high level of admissions to acute admissions wards for assessment and stabilisation). Contextual indicators on the percentage of provider spells with an invalid primary diagnosis and the percentage of provider spells with a primary diagnosis which is a symptom or sign are produced to support the interpretation of the SHMI. Notes: 1. There is a shortfall in the number of records for North Middlesex University Hospital NHS Trust (trust code RAP), Northumbria Healthcare NHS Foundation Trust (trust code RTF), and The Shrewsbury and Telford Hospital NHS Trust (trust code RXW). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 3. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. Information on the main condition the patient is in hospital for (the primary diagnosis) is used to calculate the expected number of deaths used in the calculation of the SHMI. A high percentage of records with an invalid primary diagnosis may indicate a data quality problem. A high percentage of records with a primary diagnosis which is a symptom or sign may indicate problems with data quality or timely diagnosis of patients, but may also reflect the case-mix of patients or the service model of the trust (e.g. a high level of admissions to acute admissions wards for assessment and stabilisation). Contextual indicators on the percentage of provider spells with an invalid primary diagnosis and the percentage of provider spells with a primary diagnosis which is a symptom or sign are produced to support the interpretation of the SHMI. Notes: 1. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the SHMI background quality report. 2. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. Information on the main condition the patient is in hospital for (the primary diagnosis) is used to calculate the expected number of deaths used in the calculation of the SHMI. A high percentage of records with an invalid primary diagnosis may indicate a data quality problem. A high percentage of records with a primary diagnosis which is a symptom or sign may indicate problems with data quality or timely diagnosis of patients, but may also reflect the case-mix of patients or the service model of the trust (e.g. a high level of admissions to acute admissions wards for assessment and stabilisation). Contextual indicators on the percentage of provider spells with an invalid primary diagnosis and the percentage of provider spells with a primary diagnosis which is a symptom or sign are produced to support the interpretation of the SHMI. Notes: 1. On 1st January 2025, North Middlesex University Hospital NHS Trust (trust code RAP) was acquired by Royal Free London NHS Foundation Trust (trust code RAL). This new organisation structure is reflected from this publication onwards. 2. There is a shortfall in the number of records for Northumbria Healthcare NHS Foundation Trust (trust code RTF), The Rotherham NHS Foundation Trust (trust code RFR), The Shrewsbury and Telford Hospital NHS Trust (trust code RXW), and Wirral University Teaching Hospital NHS Foundation Trust (trust code RBL). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. Information on the main condition the patient is in hospital for (the primary diagnosis) is used to calculate the expected number of deaths used in the calculation of the SHMI. A high percentage of records with an invalid primary diagnosis may indicate a data quality problem. A high percentage of records with a primary diagnosis which is a symptom or sign may indicate problems with data quality or timely diagnosis of patients, but may also reflect the case-mix of patients or the service model of the trust (e.g. a high level of admissions to acute admissions wards for assessment and stabilisation). Contextual indicators on the percentage of provider spells with an invalid primary diagnosis and the percentage of provider spells with a primary diagnosis which is a symptom or sign are produced to support the interpretation of the SHMI. Notes: 1. On 1st January 2025, North Middlesex University Hospital NHS Trust (trust code RAP) was acquired by Royal Free London NHS Foundation Trust (trust code RAL). Due to processing issues, we are currently producing separate indicator values for these trusts in the SHMI data. Data for the merged organisation will be produced at a future date. 2. There is a shortfall in the number of records for Kingston and Richmond NHS Foundation Trust (trust code RAX), North Middlesex University Hospital NHS Trust (trust code RAP), Northumbria Healthcare NHS Foundation Trust (trust code RTF), The Rotherham NHS Foundation Trust (trust code RFR), and The Shrewsbury and Telford Hospital NHS Trust (trust code RXW). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. Information on the main condition the patient is in hospital for (the primary diagnosis) is used to calculate the expected number of deaths used in the calculation of the SHMI. A high percentage of records with an invalid primary diagnosis may indicate a data quality problem. A high percentage of records with a primary diagnosis which is a symptom or sign may indicate problems with data quality or timely diagnosis of patients, but may also reflect the case-mix of patients or the service model of the trust (e.g. a high level of admissions to acute admissions wards for assessment and stabilisation). Contextual indicators on the percentage of provider spells with an invalid primary diagnosis and the percentage of provider spells with a primary diagnosis which is a symptom or sign are produced to support the interpretation of the SHMI. Notes: 1. There is a shortfall in the number of records for East Lancashire Hospitals NHS Trust (trust code RXR), Harrogate and District NHS Foundation Trust (trust code RCD), and Northern Lincolnshire and Goole NHS Foundation Trust (trust code RJL). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1) has a high percentage of records with missing data for the Sex field. Values for this trust should therefore be interpreted with caution. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the SHMI background quality report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. Information on the main condition the patient is in hospital for (the primary diagnosis) is used to calculate the expected number of deaths used in the calculation of the SHMI. A high percentage of records with an invalid primary diagnosis may indicate a data quality problem. A high percentage of records with a primary diagnosis which is a symptom or sign may indicate problems with data quality or timely diagnosis of patients, but may also reflect the case-mix of patients or the service model of the trust (e.g. a high level of admissions to acute admissions wards for assessment and stabilisation). Contextual indicators on the percentage of provider spells with an invalid primary diagnosis and the percentage of provider spells with a primary diagnosis which is a symptom or sign are produced to support the interpretation of the SHMI. Notes: 1. There is a shortfall in the number of records for East Lancashire Hospitals NHS Trust (trust code RXR) and Harrogate and District NHS Foundation Trust (trust code RCD). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. Frimley Health NHS Foundation Trust (trust code RDU) stopped submitting data to the Secondary Uses Service (SUS) during June 2022 and did not start submitting data again until April 2023 due to an issue with their patient records system. This is causing a large shortfall in records and values for this trust should be viewed in the context of this issue. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the SHMI background quality report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. Information on the main condition the patient is in hospital for (the primary diagnosis) is used to calculate the expected number of deaths used in the calculation of the SHMI. A high percentage of records with an invalid primary diagnosis may indicate a data quality problem. A high percentage of records with a primary diagnosis which is a symptom or sign may indicate problems with data quality or timely diagnosis of patients, but may also reflect the case-mix of patients or the service model of the trust (e.g. a high level of admissions to acute admissions wards for assessment and stabilisation). Contextual indicators on the percentage of provider spells with an invalid primary diagnosis and the percentage of provider spells with a primary diagnosis which is a symptom or sign are produced to support the interpretation of the SHMI. Notes: 1. There is a shortfall in the number of records for East Lancashire Hospitals NHS Trust (trust code RXR), Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1), and King’s College Hospital NHS Foundation Trust (trust code RJZ). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. Frimley Health NHS Foundation Trust (trust code RDU) stopped submitting data to the Secondary Uses Service (SUS) during June 2022 and did not start submitting data again until April 2023 due to an issue with their patient records system. This is causing a large shortfall in records and values for this trust should be viewed in the context of this issue. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. Information on the main condition the patient is in hospital for (the primary diagnosis) is used to calculate the expected number of deaths used in the calculation of the SHMI. A high percentage of records with an invalid primary diagnosis may indicate a data quality problem. A high percentage of records with a primary diagnosis which is a symptom or sign may indicate problems with data quality or timely diagnosis of patients, but may also reflect the case-mix of patients or the service model of the trust (e.g. a high level of admissions to acute admissions wards for assessment and stabilisation). Contextual indicators on the percentage of provider spells with an invalid primary diagnosis and the percentage of provider spells with a primary diagnosis which is a symptom or sign are produced to support the interpretation of the SHMI. Notes: 1. There is a shortfall in the number of records for East Lancashire Hospitals NHS Trust (trust code RXR), Harrogate and District NHS Foundation Trust (trust code RCD), and Northern Lincolnshire and Goole NHS Foundation Trust (trust code RJL). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. Data for Royal Surrey County Hospital NHS Foundation Trust (trust code RA2) has been suppressed from publication. This trust had submitted in error a high percentage of records with no secondary care diagnosis codes, this has made their SHMI values highly misleading. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the SHMI background quality report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. As well as information on the main condition the patient is in hospital for (the primary diagnosis), the SHMI data contain up to 19 secondary diagnosis codes for other conditions the patient is suffering from. This information is used to calculate the expected number of deaths. 'Depth of coding' is defined as the number of secondary diagnosis codes for each record in the data. A higher mean depth of coding may indicate a higher proportion of patients with multiple conditions and/or comorbidities, but may also be due to differences in coding practices between trusts. Contextual indicators on the mean depth of coding for elective and non-elective admissions are produced to support the interpretation of the SHMI. Notes: 1. There is a shortfall in the number of records for North Middlesex University Hospital NHS Trust (trust code RAP), Northumbria Healthcare NHS Foundation Trust (trust code RTF), and The Shrewsbury and Telford Hospital NHS Trust (trust code RXW). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. There is a high percentage of invalid diagnosis codes for Chesterfield Royal Hospital NHS Foundation Trust (trust code RFS), East Lancashire Hospitals NHS Trust (trust code RXR), Harrogate and District NHS Foundation Trust (trust code RCD), Portsmouth Hospitals University NHS Trust (trust code RHU), and University Hospitals Plymouth NHS Trust (trust code RK9). Values for these trusts should therefore be interpreted with caution. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. Information on the main condition the patient is in hospital for (the primary diagnosis) is used to calculate the expected number of deaths used in the calculation of the SHMI. A high percentage of records with an invalid primary diagnosis may indicate a data quality problem. A high percentage of records with a primary diagnosis which is a symptom or sign may indicate problems with data quality or timely diagnosis of patients, but may also reflect the case-mix of patients or the service model of the trust (e.g. a high level of admissions to acute admissions wards for assessment and stabilisation). Contextual indicators on the percentage of provider spells with an invalid primary diagnosis and the percentage of provider spells with a primary diagnosis which is a symptom or sign are produced to support the interpretation of the SHMI. Notes: 1. There is a shortfall in the number of records for East Lancashire Hospitals NHS Trust (trust code RXR), Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1), Harrogate and District NHS Foundation Trust (trust code RCD), and King’s College Hospital NHS Foundation Trust (trust code RJZ). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. Frimley Health NHS Foundation Trust (trust code RDU) stopped submitting data to the Secondary Uses Service (SUS) during June 2022 and did not start submitting data again until April 2023 due to an issue with their patient records system. This is causing a large shortfall in records and values for this trust should be viewed in the context of this issue. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. Information on the main condition the patient is in hospital for (the primary diagnosis) is used to calculate the expected number of deaths used in the calculation of the SHMI. A high percentage of records with an invalid primary diagnosis may indicate a data quality problem. A high percentage of records with a primary diagnosis which is a symptom or sign may indicate problems with data quality or timely diagnosis of patients, but may also reflect the case-mix of patients or the service model of the trust (e.g. a high level of admissions to acute admissions wards for assessment and stabilisation). Contextual indicators on the percentage of provider spells with an invalid primary diagnosis and the percentage of provider spells with a primary diagnosis which is a symptom or sign are produced to support the interpretation of the SHMI. Notes: 1. On 1st January 2025, North Middlesex University Hospital NHS Trust (trust code RAP) was acquired by Royal Free London NHS Foundation Trust (trust code RAL). Due to processing issues, we are currently producing separate indicator values for these trusts in the SHMI data. Data for the merged organisation will be produced at a future date. 2. There is a shortfall in the number of records for North Middlesex University Hospital NHS Trust (trust code RAP), Northumbria Healthcare NHS Foundation Trust (trust code RTF), The Rotherham NHS Foundation Trust (trust code RFR), and The Shrewsbury and Telford Hospital NHS Trust (trust code RXW). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. As well as information on the main condition the patient is in hospital for (the primary diagnosis), the SHMI data contain up to 19 secondary diagnosis codes for other conditions the patient is suffering from. This information is used to calculate the expected number of deaths. 'Depth of coding' is defined as the number of secondary diagnosis codes for each record in the data. A higher mean depth of coding may indicate a higher proportion of patients with multiple conditions and/or comorbidities, but may also be due to differences in coding practices between trusts. Contextual indicators on the mean depth of coding for elective and non-elective admissions are produced to support the interpretation of the SHMI. Notes: 1. There is a shortfall in the number of records for East Cheshire NHS Trust (trust code RJN), Mid Cheshire Hospitals NHS Foundation Trust (trust code RBT), and Wirral University Teaching Hospital NHS Foundation Trust (trust code RBL). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. There is a high percentage of invalid diagnosis codes for Blackpool Teaching Hospitals NHS Foundation Trust (trust code RXL), Chesterfield Royal Hospital NHS Foundation Trust (trust code RFS), County Durham and Darlington NHS Foundation Trust (trust code RXP), Nottingham University Hospitals NHS Trust (trust code RX1), Portsmouth Hospitals University NHS Trust (trust code RHU), Royal United Hospitals Bath NHS Foundation Trust (trust code RD1), The Queen Elizabeth Hospital, King’s Lynn, NHS Foundation Trust (trust code RCX), University Hospitals Birmingham NHS Foundation Trust (trust code RRK), University Hospitals of Morecambe Bay NHS Foundation Trust (trust code RTX), University Hospitals of North Midlands NHS Trust (trust code RJE), University Hospitals Plymouth NHS Trust (trust code RK9) and West Suffolk NHS Foundation Trust (trust code RGR). Values for these trusts should therefore be interpreted with caution. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. As well as information on the main condition the patient is in hospital for (the primary diagnosis), the SHMI data contain up to 19 secondary diagnosis codes for other conditions the patient is suffering from. This information is used to calculate the expected number of deaths. 'Depth of coding' is defined as the number of secondary diagnosis codes for each record in the data. A higher mean depth of coding may indicate a higher proportion of patients with multiple conditions and/or comorbidities, but may also be due to differences in coding practices between trusts. Contextual indicators on the mean depth of coding for elective and non-elective admissions are produced to support the interpretation of the SHMI. Notes: 1. There is a shortfall in the number of records for North Middlesex University Hospital NHS Trust (trust code RAP), Northumbria Healthcare NHS Foundation Trust (trust code RTF), The Rotherham NHS Foundation Trust (trust code RFR), and The Shrewsbury and Telford Hospital NHS Trust (trust code RXW). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. There is a high percentage of invalid diagnosis codes for Bradford Teaching Hospitals NHS Foundation Trust (trust code RAE), Chesterfield Royal Hospital NHS Foundation Trust (trust code RFS), East Lancashire Hospitals NHS Trust (trust code RXR), Harrogate and District NHS Foundation Trust (trust code RCD), Portsmouth Hospitals University NHS Trust (trust code RHU), University Hospitals of North Midlands NHS Trust (trust code RJE), and University Hospitals Plymouth NHS Trust (trust code RK9). Values for these trusts should therefore be interpreted with caution. 3. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. As well as information on the main condition the patient is in hospital for (the primary diagnosis), the SHMI data contain up to 19 secondary diagnosis codes for other conditions the patient is suffering from. This information is used to calculate the expected number of deaths. 'Depth of coding' is defined as the number of secondary diagnosis codes for each record in the data. A higher mean depth of coding may indicate a higher proportion of patients with multiple conditions and/or comorbidities, but may also be due to differences in coding practices between trusts. Contextual indicators on the mean depth of coding for elective and non-elective admissions are produced to support the interpretation of the SHMI. Notes: 1. There is a shortfall in the number of records for East Lancashire Hospitals NHS Trust (trust code RXR), Guy’s and St Thomas’ NHS Foundation Trust (trust code RJ1), Harrogate and District NHS Foundation Trust (trust code RCD), and King’s College Hospital NHS Foundation Trust (trust code RJZ). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 2. Frimley Health NHS Foundation Trust (trust code RDU) stopped submitting data to the Secondary Uses Service (SUS) during June 2022 and did not start submitting data again until April 2023 due to an issue with their patient records system. This is causing a large shortfall in records and values for this trust should be viewed in the context of this issue. 3. There is a high percentage of invalid diagnosis codes for Barking, Havering and Redbridge University Hospitals NHS Trust (trust code RF4), Chesterfield Royal Hospital NHS Foundation Trust (trust code RFS), East Lancashire Hospitals NHS Trust (trust code RXR), Milton Keynes University Hospital NHS Foundation Trust (trust code RD8), Portsmouth Hospitals University NHS Trust (trust code RHU), and University Hospitals Plymouth NHS Trust (trust code RK9). Values for these trusts should therefore be interpreted with caution. 4. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 5. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. As well as information on the main condition the patient is in hospital for (the primary diagnosis), the SHMI data contain up to 19 secondary diagnosis codes for other conditions the patient is suffering from. This information is used to calculate the expected number of deaths. 'Depth of coding' is defined as the number of secondary diagnosis codes for each record in the data. A higher mean depth of coding may indicate a higher proportion of patients with multiple conditions and/or comorbidities, but may also be due to differences in coding practices between trusts. Contextual indicators on the mean depth of coding for elective and non-elective admissions are produced to support the interpretation of the SHMI. Notes: 1. As of the July 2020 publication, COVID-19 activity has been excluded from the SHMI. The SHMI is not designed for this type of pandemic activity and the statistical modelling used to calculate the SHMI may not be as robust if such activity were included. Activity that is being coded as COVID-19, and therefore excluded, is monitored in the contextual indicator 'Percentage of provider spells with COVID-19 coding' which is part of this publication. 2. Please note that there was a fall in the overall number of spells from March 2020 due to COVID-19 impacting on activity for England and the number has not returned to pre-pandemic levels. Further information at Trust level is available in the contextual indicator ‘Provider spells compared to the pre-pandemic period’ which is part of this publication. 3. There is a shortfall in the number of records for East Lancashire Hospitals NHS Trust (trust code RXR) and The Princess Alexandra Hospital NHS Trust (trust code RQW). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 4. Frimley Health NHS Foundation Trust (trust code RDU) stopped submitting data to the Secondary Uses Service (SUS) during June 2022 and did not start submitting data again until April 2023 due to an issue with their patient records system. This is causing a large shortfall in records and values for this trust should be viewed in the context of this issue. 5. There is a high percentage of invalid diagnosis codes for Chesterfield Royal Hospital NHS Foundation Trust (trust code RFS), Milton Keynes University Hospital NHS Foundation Trust (trust code RD8), and West Suffolk NHS Foundation Trust (trust code RGR). Values for these trusts should therefore be interpreted with caution. 6. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 7. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. As well as information on the main condition the patient is in hospital for (the primary diagnosis), the SHMI data contain up to 19 secondary diagnosis codes for other conditions the patient is suffering from. This information is used to calculate the expected number of deaths. 'Depth of coding' is defined as the number of secondary diagnosis codes for each record in the data. A higher mean depth of coding may indicate a higher proportion of patients with multiple conditions and/or comorbidities, but may also be due to differences in coding practices between trusts. Contextual indicators on the mean depth of coding for elective and non-elective admissions are produced to support the interpretation of the SHMI. Notes: 1. As of the July 2020 publication, COVID-19 activity has been excluded from the SHMI. The SHMI is not designed for this type of pandemic activity and the statistical modelling used to calculate the SHMI may not be as robust if such activity were included. Activity that is being coded as COVID-19, and therefore excluded, is monitored in the contextual indicator 'Percentage of provider spells with COVID-19 coding' which is part of this publication. 2. Please note that there was a fall in the overall number of spells from March 2020 due to COVID-19 impacting on activity for England and the number has not returned to pre-pandemic levels. Further information at Trust level is available in the contextual indicator ‘Provider spells compared to the pre-pandemic period’ which is part of this publication. 3. There is a shortfall in the number of records for East Lancashire Hospitals NHS Trust (trust code RXR), Northern Care Alliance NHS Foundation Trust (trust code RM3) and The Princess Alexandra Hospital NHS Trust (trust code RQW). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 4. Frimley Health NHS Foundation Trust (trust code RDU) stopped submitting data to the Secondary Uses Service (SUS) during June 2022 and did not start submitting data again until April 2023 due to an issue with their patient records system. This is causing a large shortfall in records and values for this trust should be viewed in the context of this issue. 5. There is a high percentage of invalid diagnosis codes for Chesterfield Royal Hospital NHS Foundation Trust (trust code RFS), Milton Keynes University Hospital NHS Foundation Trust (trust code RD8), and West Suffolk NHS Foundation Trust (trust code RGR). Values for these trusts should therefore be interpreted with caution. 6. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 7. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. As well as information on the main condition the patient is in hospital for (the primary diagnosis), the SHMI data contain up to 19 secondary diagnosis codes for other conditions the patient is suffering from. This information is used to calculate the expected number of deaths. 'Depth of coding' is defined as the number of secondary diagnosis codes for each record in the data. A higher mean depth of coding may indicate a higher proportion of patients with multiple conditions and/or comorbidities, but may also be due to differences in coding practices between trusts. Contextual indicators on the mean depth of coding for elective and non-elective admissions are produced to support the interpretation of the SHMI. Notes: 1. On 1st January 2025, North Middlesex University Hospital NHS Trust (trust code RAP) was acquired by Royal Free London NHS Foundation Trust (trust code RAL). Due to processing issues, we are currently producing separate indicator values for these trusts in the SHMI data. Data for the merged organisation will be produced at a future date. 2. There is a shortfall in the number of records for Kingston and Richmond NHS Foundation Trust (trust code RAX), North Middlesex University Hospital NHS Trust (trust code RAP), Northumbria Healthcare NHS Foundation Trust (trust code RTF), The Rotherham NHS Foundation Trust (trust code RFR), and The Shrewsbury and Telford Hospital NHS Trust (trust code RXW). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 3. There is a high percentage of invalid diagnosis codes for Chesterfield Royal Hospital NHS Foundation Trust (trust code RFS), East Lancashire Hospitals NHS Trust (trust code RXR), Harrogate and District NHS Foundation Trust (trust code RCD), Portsmouth Hospitals University NHS Trust (trust code RHU), Royal United Hospitals Bath NHS Foundation Trust (trust code RD1), University Hospitals of North Midlands NHS Trust (trust code RJE), and University Hospitals Plymouth NHS Trust (trust code RK9). Values for these trusts should therefore be interpreted with caution. 4. A number of trusts are now submitting Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS) rather than the Admitted Patient Care (APC) dataset. The SHMI is calculated using APC data. Removal of SDEC activity from the APC data may impact a trust’s SHMI value and may increase it. More information about this is available in the Background Quality Report. 5. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of this page.

These indicators are designed to accompany the SHMI publication. Information on the main condition the patient is in hospital for (the primary diagnosis) is used to calculate the expected number of deaths used in the calculation of the SHMI. A high percentage of records with an invalid primary diagnosis may indicate a data quality problem. A high percentage of records with a primary diagnosis which is a symptom or sign may indicate problems with data quality or timely diagnosis of patients, but may also reflect the case-mix of patients or the service model of the trust (e.g. a high level of admissions to acute admissions wards for assessment and stabilisation). Contextual indicators on the percentage of provider spells with an invalid primary diagnosis and the percentage of provider spells with a primary diagnosis which is a symptom or sign are produced to support the interpretation of the SHMI. Notes: 1. As of the July 2020 publication, COVID-19 activity has been excluded from the SHMI. The SHMI is not designed for this type of pandemic activity and the statistical modelling used to calculate the SHMI may not be as robust if such activity were included. Activity that is being coded as COVID-19, and therefore excluded, is monitored in the contextual indicator 'Percentage of provider spells with COVID-19 coding' which is part of this publication. 2. Please note that there has been a fall in the overall number of spells due to COVID-19 impacting on activity from March 2020 onwards and this appears to be an accurate reflection of hospital activity rather than a case of missing data. Further information is available in the contextual indicator ‘Provider spells compared to the pre-pandemic period’ which is part of this publication. 3. There is a shortfall in the number of records for Ashford and St Peter's Hospitals NHS Foundation Trust (trust code RTK) and Royal Surrey County Hospital NHS Foundation Trust (trust code RA2). Values for these trusts are based on incomplete data and should therefore be interpreted with caution. 4. Further information on data quality can be found in the SHMI background quality report, which can be downloaded from the 'Resources' section of the publication page.