The importance of knowing context of hospital episode statistics when reconfiguring the NHS

As part of an educational initiative to support frontline staff to better understand the importance of accurately capturing and coding patient episodes, we reviewed freely available data from HESonline.1 2 We found some interesting statistics.

On average, 1600 adults aged over 30 apparently attend outpatient child and adolescent psychiatry services in England each year (figure⇓). Indeed, the number of adults attending outpatient paediatric services since 2003 has increased steadily, with a steep increase, to nearly 20 000, in 2009-10.3 Adults over 60 are also being admitted to inpatient paediatric and inpatient child and adolescent psychiatry services.3

Top: Outpatient attendances to child and adolescent psychiatry by those aged from 30 to 90 and over. Middle: Outpatient attendances to geriatric medicine by those aged 0-19 years. Bottom: Male inpatient admissions to obstetrics and gynaecology, as well as midwife episodes

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We are not clear why so many adults seem to be availing themselves of paediatric services, but it might be part of an innovative exchange programme with paediatric patients attending geriatric services. The number of 0-19 year olds attending outpatient geriatric medicine services has increased steadily, with over 3000 attendances in 2009-10 (figure⇑). However, the number of inpatient admissions to geriatric medicine and old age psychiatry by 0–14 year olds has remained fairly constant.3

We were quite surprised to discover that many males seem to be attending outpatient obstetrics, gynaecology, and midwifery services.3 Amazingly, between 2009 and 2010, there were over 17 000 male inpatient admissions to obstetric services and over 8000 to gynaecology with nearly 20 000 midwife episodes (figure⇑).

These statistics seem to reveal some interesting service developments, but, although we applaud innovation, we suspect that the numbers may, at least partly, reflect data errors. Some of these may be due to similarities in the main specialty codes.3

How services in the NHS are commissioned is changing dramatically.4 We hope that data will inform decision making during this process. Perhaps we should all examine the data being submitted by and about our services for unintentional innovation.