SCoOP Acute Hospital Outcomes Report 2018-2019: An overview of outcomes of acute geriatric medicine services in Scotland

SCoOP is an ambitious project. Evaluation variation and benchmarking older peoples care is wider than the specialty of geriatric medicine or acute hospitals. Nevertheless, this SCoOP report – the second of its kind forms a provocative piece to explore the experiences of a large proportion of older people in acute care. All metrics have their limitations and as with all benchmarking their goal should be to seek to provoke self-examination and discussion as well as drive improvement and reduce variation. There is a significant and consistent rise in inpatient admissions across Scotland with a 32% rise in admissions over four years: this will undoubtedly have created additional pressures on the specialty who have delivered care within a broadly similar bed base through improved efficiencies and throughput. There are however still wide variations across the country in activity levels and length of stay that are not simply explained by casemix. Reassuringly, despite this increased activity, mortality rates have fallen slightly and readmissions have not risen. Also reported here are data from across Scotland for Hospital at Home services, which is a rapidly developing sector of specialist acute care that may expand in future reports, and has seen a 5-fold increase in activity.
This is the first SCoOP report to include some metrics on casemix. This will naturally vary by geographic catchment area across Scotland as best illustrated by differences in Depcat 1 Score (most deprived) in Glasgow Royal Infirmary and Depcat 5 (least deprived) in Edinburgh Royal Infirmary. Nevertheless, deprivation and casemix alone cannot explain all the variation seen in performance and teams should consider the configuration of services, staffing and efficiency of their services in light of this variation.