Consultant Episode (Hospital Provider)
1. Multiple Consultants during admission
A Patient is admitted by Consultant A and, whilst an admitted Patient is treated by Consultant B and then subsequently discharged by Consultant A, B or even C. How should this be handled? Can a Patient be treated under more than one Consultant during an admission?
A Hospital Provider Spell can consist of multiple Consultant Episodes (Hospital Provider), a new one will be initiated when the responsibility for the Patient is transferred from one Consultant to another. Therefore it is possible to record care delivered by one or more Consultants during a Hospital Provider Spell. Further, the Consultant responsible for the Patient on admission may not be the same as the Consultant responsible on discharge, this is reflected in the Consultant Episodes recorded for each Consultant.
Currently the Admitted Patient Care Commissioning Data Sets require the submission of Consultant Episodes for a Hospital Provider Spell, accurately reporting the Consultant responsible for a Patient on admission, discharge and in between.
2. Transfer during delivery
Can you please let me know whether a mum-to-be, who is admitted under a Midwife, and has an epidural given by an anaesthetist during delivery, should have a Consultant transfer to the obstetrician for the epidural, then a Consultant transfer back to the midwife for the rest of the labour/delivery - or is the mum-to-be admitted under the Midwife for the complete Hospital Provider Spell?
A Consultant transfer may be instigated if it is intended to transfer the responsibility for the care of the Patient to the obstetrician. If the obstetrician will be assuming responsibility the Patient is transferred to the Consultant's care, and transferred back to the Midwife if the Midwife is assuming responsibility following the epidural.
3. 'Finished' Consultant Episode
The concept of Finished Consultant Episodes and the abbreviation FCE is widely used in the NHS. The NHS Data Model and Dictionary refers to Consultant Episode (Hospital Provider), it uses phrases such as "finished Consultant Episode (Hospital Provider)" but does not define Finished Consultant Episode specifically.
Commissioning Data Sets Version 6 refers to Finished General Episodes. Could you clarify the status of the phrase "Finished Consultant Episode" and the abbreviation "FCE" in the context of the NHS Data Model and Dictionary i.e. are they meaningful, were they ever defined in the past as 'official' NHS terms, or are they simply informal terms?
Does the NHS Data Model and Dictionary define the concepts of unfinished and finished in terms of Consultant Episodes?
The NHS Data Model and Dictionary contains a definition of Consultant Episode (Hospital Provider) and Consultant Episode (Acute Home-Based) but not "Finished Consultant Episode". When a Consultant Episode ends, the episode is finished. If the Consultant Episode has not ended, it is unfinished.
4. Episode start date
I am converting bulk update submissions to CDS version 6. I am being told by our supplier that the Consultant Episode Start Date has to fall between the report period start and report period end dates even though we run a quarters data at a time and have very long stay Patients. Please can you clarify further?
The Consultant Episode Start date is used in the Commissioning Data Set to derive the CDS Activity Date which must be present and valid for all CDS Types. The CDS Activity Date is held in the CDS Transaction Header Group and is a mandatory data element for all Commissioning Data Set Types and all uses of the CDS Exchange Protocol. This date is validated by the Secondary Uses Service (SUS) and CDS Interchanges are rejected if the date is not present, invalid or not compatible with the CDS Exchange Protocol controls being used. In particular, when using the CDS Bulk Replacement Update Mechanism, the CDS Activity Date and its CDS Originating Date are used by the Secondary Uses Service to validate that the CDS TYPE date applicability falls within the CDS Report Period Start Date and the CDS Report Period End Date.
5. Episode Number limit of 87
The NHS Data Model and Dictionary puts a limit of 87 Consultant Episodes (Hospital Provider) to a Hospital Provider Spell, yet we have had more than one Patient in the last year who has had more than 87 Episodes. This is causing us problems as the Healthcare Resource Group (HRG) grouper is therefore not taking into account all the activity in the Hospital Provider Spell and is therefore potentially allocating an incorrect HRG.What is the reason for limiting the number of episodes to 87 and is there any prospect of changing this?
The Information Centre for Health and Social Care Casemix team have confirmed that the grouper has been designed to adhere to the NHS Data Model and Dictionary 87 episode limit to 'EPISODE NUMBER' which states that "A known EPISODE NUMBER can be between 01 to 87". The National Casemix Service does not have a recommended solution for this, since it is unusual to have a Hospital Provider Spell with this number of Consultant Episodes (Hospital Provider).
From a NHS Data Model and Dictionary perspective new Consultant Episodes should only be started when the responsibility of the Patient is completely transferred from one Consultant to another Consultant within a Hospital Provider Spell. In these situations there should be a clear record in the Patient's case notes of the clinical decision to transfer and handover the care of the Patient to another Consultant. This should not be confused with where an admitted Patient attends an Out-Patient Appointment during the Hospital Provider Spell as the NHS Data Model and Dictionary advises that:
"A PATIENT may not have concurrent Consultant Episodes (Hospital Provider) but can have Consultant Out-Patient Episodes overlapping with a Consultant Episode (Hospital Provider)."
The upper limit on Consultant Episodes (Hospital Provider) within a Hospital Provider Spell is a legacy restriction based on the understanding that it would be unlikely for this number to be exceeded. If however you feel there could be a national requirement to increase this upper limit please contact the Data Sets Team at the Information Centre for Health and Social Care on firstname.lastname@example.org.