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System Watch Dashboard – User Guide

This User Guide provides a comprehensive introduction for navigating the new System Watch Dashboard. It will allow users to interact with the data, produce and share bespoke analyses with colleagues.

Background

NHS Scotland is subject to seasonal variation in the public’s demand for medical services it provides. Demand for these services increases during the winter period. System Watch monitors and predicts urgent and emergency care for NHS services across Scotland providing supporting information for users from Site Capacity Leads, Service Improvement Leads, Analysts, Clinicians and Service Managers to plan how best to meet those demands. System Watch uses data from a variety of sources supplied by Health boards and other health organisations.

System Watch has been available to NHS users since 2001. The web address: www.systemwatch.scot.nhs.uk. As at 30 September 2018, System Watch Team will be replace the old HTML version with new flexible interface based in Tableau Software.

New System Watch Dashboard

The System Watch Team have developed a new dashboard presented in Tableau Software to give users greater flexibility to develop bespoke analyses to meet their analytical and planning needs. The Team will continual to work with users to develop the new dashboard to enhance System Watch’s functionality to meet its users’ future needs.

Access to System Watch

This new System Watch dashboard is available at: https://eviz.nhsnss.scot.nhs.uk/. Access to the System Watch dashboard can be requested through NSS’s user access system https://useraccess.nhsnss.scot.nhs.uk or contact the team directly at NSS.isdSYSTEMWATCH@nhs.net to request access.

System Watch provides time series analysis for:

Routine hospital admissions data (daily and weekly) with future predictions;

Emergency Bed Occupation data (daily and weekly) with future predictions;

Primary Care Out of Hours: number of contacts and seasonal figures;

NHS 24 contacts;

Scottish Ambulance Service (SAS) call outs;

A&E Attendances.

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All other information available through the original System Watch website is being developed for the new dashboard. Team are currently developing the following areas:

More timely A&E information

Weekly Deaths information

GP consultations for influenza like illness

Please see the User Support web page for a link to the User Access System and more information.

Get involved with System Watch – Help shape its future

If you are keen to find out more about what the System Watch Team are working on, or have any comments or feedback about the new dashboard or User Guide you can contact us at: NSS.isdSYSTEMWATCH@nhs.net.

The system watch Team are looking to identify local “System Watch Champions” within the NHS Health Boards. If this is something that is of interest to you please contact the NSS.isdSYSTEMWATCH@nhs.net.

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System Watch Information Page

At the top of the “Information” page tabs allow users to select the different dashboards of System Watch. Blue

arrows halfway down the “Information” page will direct users to specific dashboards. The information “i” for management information at the top of the page gives background on what is management information and how it differs to Official Statistics common in ISD publications. An “email” icon, at the top of the page, will allow users to contact the System Watch Team with any queries, operational questions or feedback. Below the blue navigation arrows lists the ongoing development work the System Watch Team are working on. At the bottom of

the webpage, the information icon provides links to the System Watch Technical Documentation. The Technical Documentation explains the different aspects of data quality and caveats surrounding these data. Each dashboard provides separate links to their Technical Documentation.

Contact the System Watch Team

Info panel about management information

Blue arrows connect to the individual dashboards

Development work being carried out by the System Watch Team

Info panel: Links to Technical info

Dashboard Tabs

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What do you want to do?

Day to day management of bed resources

o See how many emergency admissions there have been each day at a NHS Board / hospital and how many are predicted for each day in the near future.

Capacity planning

o View a full year of emergency and elective admission numbers at a NHS Board/hospital by Speciality Group including predictions for the next six weeks and expected seasonal levels for the next 12 weeks.

Comparison with neighbouring boards

o Compare the number of emergency admissions there have been in a month between boards.

Workforce planning for Primary Care Out of Hours’ services

o View the number of daily contacts at Primary Care Out of Hours Services along with the seasonal number for your NHS Board.

Keep up to date with recent trends across emergency and urgent care services

o View number of hourly and daily contacts with the Scottish Ambulance Service, NHS 24, A&E and Primary Care OOHs services along with the longer term trends for your NHS Board.

Monitor Developing Trends in Syndromic Data

o Compare HPS data on flu consultation rates over a number of years. o Target periods of interest for closer examination and comparison. o Compare developing trends between health boards. o Compare trends in HPS flu consultation data with NHS24 respiratory calls.

Set up an alert to notify you if threshold values are exceeded

o Alerts can be set on any indicator (number of admissions, flu rates, A&E attendances) if a chosen value is exceeded.

Create Personalised Data Views

o Views specific to your needs can be created and saved for future reference.

o Alerts can be set on these views allowing maximum flexibility.

Share Views

o Facilitate discussion by emailing charts of interest.

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System Watch: Dashboard Overview

User Options The above figure shows the Main System Watch Dashboard layout. Users have a number of options to select from drop down menus to display the data they need for their analysis.

1. Scotland or NHS health Board; o Due to the size of NHS Orkney and NHS Shetland they are excluded from this analysis;

2. Select NHS board level or individual hospital; o The information provided is broken down by hospital as well as for complete NHS boards. o However, it should be noted that the predictions and seasonal trends are calculated by scaling

down predictions for the whole board and therefore any fluctuations due to local decisions/events (e.g. ward closures, a hospital being closed to emergency admissions, change in catchment area) are unlikely to be reflected immediately.

o In general it is suggested that predictions for individual hospitals should be interpreted with caution.

3. Select Speciality: o Select between: All, Medical, Surgical or Paediatric;

4. Select type of Emergency Data: o Emergency “Admissions” or “Beds Occupied” from an emergency admission;

5. Select to “Show” or “Hide” Elective Data: o When “Show Elective Data” is selected it will show the equivalent planned data for the type of

emergency data selected above in step 5.

6. Select between weekly or daily timeline views:

1. Select the NHS Board

2. Select the hospital – the hospitals within the selected board will be available.

3. Select speciality: - All, Medical, Surgical or Paediatric

4. Select number of emergency admissions or occupied beds from emergency admission to view trends and predictions.

5. Hide or Show Elective Data

6. Weekly or Daily viewSelect speciality: - All, Medical, Surgical or Paediatric

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o Select “Weekly” to show information for the whole of the current year and can be used to monitor annual and seasonal trends, and provides predictions for the next six weeks;

o Select “Daily” to monitor the effect of fluctuations in emergency admissions on different days of the week, and provides predictions for the next three weeks;

Select between a “Zero Axis Start” or “Variable Axis Start”; o This allows the user to change scale of the Y-axis to resize the chart to view more or less detail of

the times series, or compare magnitude of difference between emergency data and elective data.

Chart Legend

Actual emergency is the observed number of emergency admissions or emergency beds occupied by day or week.

Actual elective is the observed number of elective (planned) admissions or elective (planned) beds occupied in a day or week depending on what emergency data has been selected: emergency admissions or emergency beds occupied. These data are obtained from the weekly RAPID hospital admissions information submitted by NHS Boards.

Seasonal emergency figures are calculated using the patterns observed within each hospital since October 2009 and are more heavily weighted towards average levels in recent years. The seasonal line takes into account seasonal and weekday variation and allows for the effects of holiday periods. The seasonal trend can be interpreted as a longer time series of the likely pattern in number of admissions/beds, but bear in mind it will not identify a flu outbreak or severe winter in advance. In the example above, the number of admissions is higher than the seasonal average – there are more admissions this year than at the same time in previous years:

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Predicted Emergency is the red line shows the predicted emergency admissions or the predicted bed occupancy for emergency admissions. When viewing daily data the prediction will look ahead for three weeks, and when viewing the weekly data the prediction will look ahead for six weeks.

If the graph does not have a red line, then the hospital chosen does not have any predictions. This happens where the hospital is too small for useful predictions to be made or where significant service redesign has happened. The red shaded area around the line is the 95% confidence interval for the prediction. Note in the above example the confidence interval is quite large, this reflects the difficulty in predicting admissions/beds and the variation unexplained by seasonality and weekday.

Understanding Predictions

The margin of error for the prediction is present below the chart next to the legend. The margin of error shows the accuracy of the historical predicted values. It is half the width of the confidence interval, red shaded area in the chart.

In the above example, historical admissions for Scotland have been accurate within +/- 146.2 admissions for predictions 1 week ahead and within +/- 164.4 admissions for predictions 6 weeks ahead.

Chart View A new feature to view data values has been added to the charts. When the mouse hovers over one the time series in the chart a pop-up window will appear displaying that specific date data values for each time series. This allows users to check specific values for any date in the time series.

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User example 1: Daily emergency admissions

For day-to-day management of bed resources, it may be of interest to see how many emergency admissions there has been each day at a particular hospital and the number of predicted admissions each day in the near future. For example: to look at the number of emergency admissions for all specialities at a particular hospital, select the following options for a particular Health Board and Hospital:

The above chart shows:

Data from the start of the year until mid February. On Sunday the 18th there were 52 emergency admissions.

There are fewer emergency admissions at the weekend and more admissions on a Monday throughout the time period.

In January, the number of admissions was higher than the seasonal average, with peaks on the 15th and 22nd January.

In recent weeks the number of admissions has been closer to the seasonal average.

The model predicts in the week ahead the numbers of admission will continue to be above the seasonal average.

The range for the predicted number of emergency admissions on Monday 19th February is 51 to 78; centring on 64.

When using System Watch to plan services, take into consideration the predicted range and the margin of error (highlighted in red in the above chart) which explains the accuracy of recent predictions.

Select Variable Axis start if you want to focus on the variation in the data

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User Example 2: Annual Planning For capacity planning for the future, it is possible to view a full year of emergency and elective admission numbers at a hospital by Speciality Group including predictions for the next six weeks and expected seasonal levels for the next 12 weeks. To do this, make the following selections:

This chart shows:

The number of emergency admissions was less than predicted between the 22nd of July and the 23rd of September.

The number of emergency admissions was greater than predicted from the end of the November until the 30th of December.

The number of admissions was the less than predicted until the 27th of January.

The model predicts in the weeks ahead the numbers of admission will be below seasonal averages.

The range for the predicted number of emergency admissions on Monday 19th February is 447 to 713; centring on 580.

Historical admissions for the hospital have been accurate within +/- 73.2 for predictions 1 week ahead, and within +/- 86.5 admissions for predictions 6 weeks ahead.

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User example 3: Board Comparison

Users can also compare admissions between two or more boards. This functionality can be found at the bottom of the System Watch page:

The boards can be selected from the dropdown menu and then clicking apply:

Note: the same axis scale will be used across boards so we recommend comparing boards of similar size.

Board A

Board B

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The above charts show:

Board A has consistently had lower admissions than Board B, however both Boards have similar peaks and drops in attendances:

o Both boards had fewer attendances than predicted at the end of October. o Both boards had a spike in attendances in the middle of August and from the 15th of December

until the end of the year.

The model predicts that in the weeks ahead the numbers of admission will be below seasonal averages for Board A and above average for Board B.

The range for the predicted number of emergency admissions in the next week is between 136 and 306 centring on 222 for Board A and between 278 and 455 centring on 366 for Board B.

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Patient contacts with Primary Care OOH services:

Patient contacts with Primary Care Out of Hour (OOH) services are shown for each NHS board and Scotland. The information presented includes patients who have had a contact with Primary Care OOH Services e.g. attending a Primary Care Emergency Centre/Primary Care Centre (PCEC/PCC), a Home Visit or an OOH GP/Nurse Advice Call. The data presented covers only the standard OOHs period – weekday evenings (6pm-8am), weekends and national public holidays (Easter, Christmas and New Year only).

A calendar heat map is the default chart for presenting the number of contacts made to Primary Care OOH Services by date and by time of the day. The data is available by board and year. A calendar heat maps cell colour will change depending on the number of contacts recorded for each date. The shading will change from light grey to red as the activity level increases.

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To view OOH data date use the drop down menu Select Month(s) to view to selects specific month or months of interest. To breakdown the OHH data by day use the Select Date(s) drop down menu to view the distribution of contacts over a 24 hour period.

Example of the 24 hr view of Out of Hours data:

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How to interpret the OOH seasonal line

The grey line is the seasonal line. This is calculated using the patterns observed within each hospital since the beginning of routinely collected data (April 2014). The seasonal line takes into account seasonal and weekday variation and allows for the effects of holiday periods. The seasonal trend can be interpreted as the likely pattern of the number of cases in future weeks, but will not identify a flu outbreak or other factors causing an increase in patients seeking OOHs appointments.

User example 4: Primary Care OOHs If we were interested in analysing the number of contacts with GP OOH for a particular board over the Christmas period in 2017 we would make the following selections:

This chart shows that:

The number of contacts was much higher on the 23rd, 24th 26th, 30th and 31st of December than the rest of the month.

Looking at the hourly breakdown, activity was much higher between 9am and 12pm on Saturdays and Sundays throughout the month.

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We could then look closer at the 30th and 31st of December by selecting:

The graphs of the hourly breakdown by day show:

The contact number was overall higher than predicted across both days.

There was a peak on the 30th at 9am and 1pm and on the 31st at 11am.

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Emergency & Urgent Care Services Overview:

Patient contacts with Emergency & Urgent care services are shown for each NHS board and Scotland. The services include: Scottish Ambulance Service (SAS), NHS 24, Accident and Emergency (A&E) and Minor Injury Unit (MIU) Attendances and Primary Care OOH:

The SAS data includes incidents where a crew has attended (arrived on scene). It excludes air ambulance records and records from crews which were cleared from an incident with reason of ‘dealt with by another vehicle’. NHS 24 data covers all clinical and dental calls but excludes calls to NHS Inform for advice only. The data are refreshed weekly from ISD’s Unscheduled Care database, however, the Primary Care OOHs and A&E data are only updated monthly. The default charts presents the number of contacts emergency and urgent care services contacts by hour and day for the past 7 days and can be filtered by board:

Users also have the ability to select a start date out with the past seven days and then select the number of days they wish to view:

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Longer term trends of the four services by week of the year for a given time period, can be viewed scrolling further down on the webpage. Users are able to select the time period of interest which can range from April 2014 to present and will be filtered by the previously selected board. The activity for the dates selected will then be shown for the four services:

The final graph on the page allows users to drill into a particular service for a board and date range of interest:

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Once the user has selected the measure, time period and board a daily overview of the service per hour will be displayed:

The average week shown on the graph is the average for the weekday/hour across the full time period.

User example 5: Emergency care & urgent services If we were interested in analysing the number of contacts with the four services for a particular board over the Christmas period in 2017 we would make the following selections:

The graphs of hourly breakdown by day show:

The number of NHS 24 records peaked on the 23rd and 24th of December between 7am and 2pm.

A similar peak was observed on the same days during the same time period for primary care OOH cases.

On Christmas day (25th of December) all services observed lower numbers than in the days before and after.

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We could then compare the observed numbers from Christmas 2017 to the same time period in 2016.

From the below graph we can see that all services again had a peak on the 26th of December, there was larger volumes of contact in 2017:

If we wanted to look closer at the NHS 24 records at this time period we would select the following options on the final graph of the page:

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From the graph we can see:

Across all days a greater number of OOH cases per hour than the average week.

A peak in contact with OOH services between 7am and 2pm on the 24th of December.

Lower contact numbers on the 25th of December.

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Example 6: Syndromic Indicators Dashboard This dashboard displays time series by year for the following indicators:

These Indicators can be filter by:

Board

Source: o HPS (Health Protection Scotland), NHS24 & All (Combined HPS & NHS24).

Age (Not available for individual boards): o Age categories: Under 15, 15 to 44, 45-64, 65 to 74, Over 74.

These filter options modify all the charts except ‘Board Comparison’.

Year on Year Comparisons Chart

The Select Year(s) drop menu can select any combination of the years available for each indicator. Selecting a particular year in the chart legend will highlight that year from the other years displayed. To see the exact value of a data point in the chart hovering over a data point with the mouse and a pop up window will appear providing the data values for the selected data point. See below. The peaks of these syndromic indicators occur at the turn of the year. To avoid the peak being split in two and produce an uninterrupted peak for each indicator the times series runs from week 40 of year 1 to week 39 of year 2.

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What does the indicator show? The flu consultations per 100,000 of the population indicator shows:

An unusually high peak in flu consultations in 2018 when compared with recent years.

It is also possible to observe from week 49, 5 weeks before the peak, an elevated level of consultations relative to previous years.

It is worth noting that in 2018 both the increased consultation rates, and peak week, varied between boards. Examination of this data, across a range of boards can indicate a rise in consultations prior to them occurring within the board of interest.

Threshold levels - Flu consultations per 100,000 of the population indicator only To aid interpretation of the rate of flu consultations per 100,000 of the population for comparison with previous years, the UK has adopted a standardised method of reporting influenza activity, the Moving Epidemic Method (MEM), used by the European Centre for Disease Prevention and Control. MEM method uses historical data (using the previous 10 seasons’ data) to evaluate the timing and duration of an influenza epidemic through a series of cut points, baseline, low, medium, high and very high thresholds, and allows for comparability across the UK countries. A breach of the initial baseline threshold indicates the start of influenza activity or circulation. Subsequent thresholds breaches indicate the intensity of influenza activity in a particular season. The thresholds are for 2017/18 and will change flu season on flu season when the most recent season’s data becomes available. This Moving Epidemic Method (MEM) model took into consideration data from seasons 2006/07 – 2008/09 and from 2010/11 to 2016/17, i.e. excluded pandemic year. For Scotland level the flu consultations per 100,000 of the population indicator provides three threshold levels to help interpret the data. Do not use thresholds at board area level.

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Weekly View Trend

Default view is all weeks and all years. To change the indicator select a different one from the Indicator drop down menu at the top of the dashboard.

The Select Year(s) drop menu can select any combination of the years available for each indicator. The filter by option allows users to choose between selecting dates or week numbers to view a specific time period. Users can add a reference line of their choosing to provide context to the chart. The legend shows which age groups are active in the chart. The age groups are selected from the Age drop down menu at the top of the dashboard. To see the exact value of a data point in the chart hovering over a data point with the mouse and a pop up window will appear providing the data values for the selected data point. See below. View when January has been selected by following the procedure outlined above in the “Long Term Trend.”

The chart shows

The data for the four weeks of January for each of the selected years.

This allows focus to be placed on a specific period of interest (e.g. peak flu period)

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Board Comparisons

This chart allows the rate of GP consultations for influenza like illnesses to be compared to other board areas. The chart can be modified in the following manner:

1. Select the year of interest; 2. Select the weeks of the interest; 3. Select the board areas for comparison; 4. Select a particular board area to highlight its time series on chart to help make comparisons with.

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All Activity by Board (Scotland Level analysis)

In this chart the three indicators may be compared: HPS data on flu consultations, NHS24 data A contacts, Respiratory contacts and Diarrhoea & Vomiting. The chart is intended to allow comparison between trends rather than absolute values. The chart can be modified in the following manner:

1. Select the year of interest; 2. Select the weeks of the interest;

3. Select the indicators for comparison.

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User Example 7: Be Alert Within System Watch there is the option to set an alert should a variable (e.g. admission rates) exceed a user specified threshold. This feature is available to all charts with a continuous variable for one of the axis. However, the technique for setting alerts on the default page and on a page modified by a user (e.g. setting a filter to view an individual board) are slightly different. Setting an Alert on the Default Page

1. Select the continuous variable on the chart of interest; 2. Click the bell icon; 3. Enter the threshold details to trigger alert; 4. Set-up a distribution list of other System Watch users to receive this alert email.

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The system also allows the frequency of alarms to be set (varying from hourly to weekly), and for the creation of a list of email recipients. Setting an Alert on a User Modified View If the view has been modified when selecting the alert button the user will see the following message “You’ve customised this view ....... and save your version”. In this case follow the instructions in User Example 8: Creating Personalised Views. Having completed this process the procedure is as above.

User Example 8: Creating Personalised Views This allows users to set personalised views, by presetting the filters (e.g. Health Board, Hospital etc) and then saving the settings for ease of future access.

Setting a Personalised View

Select View

Enter a name in Name this View

You can then set this page as default if so desired.

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User Example 9: Share Personalised Views This allows users to share personalised views between individuals with System Watch access. Access to the System Watch dashboard can be requested through NSS’s user access system https://useraccess.nhsnss.scot.nhs.uk or contact the team directly at NSS.isdSYSTEMWATCH@nhs.net to request access.

1. Follow the procedure above to create a personalised view. 2. You must be on the page of the personalised view in order to share it. 3. Select Share 4. Select Email Link

It is important to note that if you delete the personalised view then anybody with whom you have shared this view will no longer be able to see it!