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Casemix Healthcare Resource Group update
  1. Nigel Brayley1,
  2. Cheryl Day2,
  3. Jonathan Marrow3,
  4. Janet Porter4
  1. 1Accident and Emergency Department, Colchester General Hospital, Turner Road, Colchester, Essex CO4 5JL
  2. 2Project Manager, NHS Information Authority (Casemix Programme)
  3. 3Arrowe Park Hospital, Wirral, Merseyside
  4. 4Chairman, Clinical Services Committee (BAEM)

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    Editor,—The accident and emergency (A&E) medicine clinical working group of the Casemix Office (part of the NHS Information Authority) has selected six pilot sites to take part in a study leading to refinement of the A&E medicine Healthcare Resource Group (HRG). The chosen sites are as follows (attendances in previous year in thousands):

    • Leeds General Infirmary (96)

    • Derbyshire Royal Infirmary (78)

    • Sandwell District General Hospital (72)

    • Princess Alexandra Hospital, Harlow (60)

    • Stoke Mandeville Hospital (39)

    • Harrogate District Hospital (35)

    Other departments are thanked for submitting high quality bids but it was essential to represent a broad cross section of emergency departments.

    The current HRG A&E casemix measure version 1.0 uses disposal data that are already collected and are generally comprehensible. The A&E HRGs also have a specificity or reduction in variance for allocating appropriate grouping around costings and complexity of activity, which is currently better than that of any other specialty.1

    Korner returns to the NHS of departmental activity using the A&E HRG are expected from hospital information departments June 1999 where possible, but are compulsory from June 2000.

    The refinement projects will look at the potential of the national triage scale (NTS) and details of how long a patient stays in the department, to see if they provide a further reduction in variance and can be easily collected to drive our HRG.2

    Work to date on this refinement project anticipates making recommendations to seek changes in the minimum dataset to include the NTS triage groupings, a separate investigation code for more expensive radiological investigations, such as intravenous urography, and a treatment code to identify patients receiving thrombolytic treatment.

    The change from “finished consultant episodes” to so-called “spells” could lose our departments funding for the care of patients awaiting admission in A&E departments and not formally under our care. The pilot sites are therefore being asked to develop ways of identifying patients who are cared for within the A&E department but do not form part of the medical responsibility of A&E staff so that the burden that these patients place on our departments can be better evaluated. All general practitioner admissions activity should be triaged and flagged as A&E activity so that data analysis around this group can be undertaken.

    The activity undertaken as outpatient work by consultants at scheduled review clinics is specifically excluded from this project, but will be covered in turn by the Outpatient HRG Development Project.

    Observation ward activity (or spells) can be counted using the relevant existing inpatient HRGs.3

    The whole project is due to report initial findings within the financial year. The current baseline project plan identifies a completion date of June 2000. We do not underestimate the hard work that will be necessary by the selected sites and the Casemix Office to deliver this refinement of our casemix measure. We owe them a debt of gratitude, especially when several of the sites will also be modernising their departments at the same time.


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