One in 50 episodes of care commissioned by the NHS, in NHS hospitals or the independent sector, in England resulted from a complication between July 2008 and June 2009, provisional figures released by The NHS Information Centre show today.

This equates to 326,000 (two percent) of the 16.3 million episodes during this period, a slight rise compared to the previous 12 month period when 295,000 (1.9 percent; or one in 53) of the 15.6 million episodes resulted from a complication.

A hospital episode relates to a patient's period of care under one consultant during their hospital stay.

Complications relate to four areas of medical and surgical care in hospital. Between July 2008 and June 2009:

• 95,930 complications (29 per cent of all complications) involved an adverse affect on a patient from drugs used in their treatment.
• 5,050 complications (two per cent of all complications) involved misadventures to the patient during surgical and medical care.
• 3,690 complications (one per cent of all complications) involved an adverse incident relating to medical devices used for diagnosis or therapy.
• 221,150 complications (68 per cent of all complications) involved an abnormal reaction by a patient some time after a surgical or medical procedure, where misadventure was not mentioned at the time of the procedure.

The figures are part of a new special topic from Provisional Monthly HES for Admitted Patient Care, which is now published monthly to provide up-to-date information and demonstrate approximate trends. Information must be seen as provisional, as it has not been subject to final checks and revisions ahead of annual publication and can be subject to change. This is particularly true of June 2009. Previous provisional data has been slightly lower than the final data published in annual publications.

The publication also includes two other special topics relating to hospital care; Bariatric surgery; and also the Tackling Knives Action Programme (TKAP), relating to a cross-government programme to reduce incidents of death and serious violence among 13 to 24-year-olds in target areas in England and Wales. The NHS Information Centre has previously published special topics on both subjects.

The TKAP special topic, which previously looked at admissions due to assault by sharp object to reflect the first phase of the programme, now includes for the first time provisional admissions information for all assaults, reflecting the expansion of TKAP in April 2009. Provisionally, between July 2008 and June 2009, for this particular measure of impact of the programme, there were:

• 43,440 admissions across all age groups in all areas for assault, a 2.2 per cent increase on the previous 12 month period, when there were 42,490 admissions. 62.4 per cent of admissions were in TKAP local authorities, compared to 62.7 per cent in the previous 12 month period.
• 27,100 admissions across all age groups for assault in TKAP local authorities, a 1.7 per cent increase on the previous 12 month period, when there were 26,650 admissions.
• 16,340 admissions across all age groups for assault in non-TKAP areas, a 3.2 per cent increase on the previous 12 month period, when there were 15840 admissions.
• 10,860 admissions for 13 to 24-year-olds within TKAP areas, a decrease of 120 (1.1%) from the previous 12 month period.

NHS Information Centre chief executive Tim Straughan said: “This is the first time The NHS Information Centre has published a special topic about complications during a patient's hospital stay. Provisionally it appears one in 50 hospital episodes involve a complication and two thirds of those arise at some point following a surgical or medical procedure.

“It is important to note that complications can occur as a result of patient's physical reaction to treatment that was not able to be predicted, rather than arising due to any fault of the medical professionals involved. Trends may also include effects of any changes in data recording and clinical coding practices. This information will be useful however to help the NHS examine possible reasons for complications and improve the quality of patient care.”

Regional information is available from this publication.

To access the special topics visit www.hesonline.nhs.uk.

ENDS

Notes to editors

1. The NHS Information Centre is England's authoritative, independent source of health and social care information. It works with more than 300 health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work. The NHS Information Centre also produces a wide range of statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.
2. HES provisional monthly data can be used for high level, aggregate analysis demonstrating approximate trends in activity. Lower level analysis should be approached with caution as not all activity will be correctly processed until the final annual data is produced.
3. Complications are defined within ICD-10 as Complications of medical and surgical care (Y40 to Y84), where the 'cause' of the patient episode in hospital is directly related to the complication. Complications are divided into four distinct groups, these are:
   
   - 40-Y59 (Drugs, medicaments and biological substances causing adverse effects in therapeutic use)
   
   - Y60-Y69 (Misadventures to patients during surgical and medical care)
   
   - Y70-Y82 (Medical devices associated with adverse incidents in diagnostic and therapeutic use)
   
   - Y83-Y84 (Surgical and other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure) A full list of codes is available at www.hesonline.nhs.uk
4. The TKAP local authorities (LAs) are a list of LAs of residence provided by the Home Office. TKAP areas are not coterminous with local authorities but this list of LAs provides a good approximation. From April 2009 TKAP moved into its second phase and has extended the number of police forces it involves from nine to 14. There has also been a minor update to the LAs used in TKAP phase 1 to include Ribble Valley, Rushcliffe, and Vale of White Horse. The inclusion of these LAs has a negligible impact on figures for the original nine TKAP Phase 1 areas. The TKAP areas involved in phase 1 and 2 are: Essex;Greater Manchester; Lancashire; Merseyside; Metropolitan; Nottinghamshire; Thames Valley; West Midlands; West Yorkshire; Kent; Bedfordshire; Hampshire; Northumbria; South Yorkshire.
5. The ICD-10 codes used to calculate assault admissions are: X85 Assault by drugs medicaments and biological substances; X85 Assault by drugs medicaments and biological substances; X86 Assault by corrosive substance; X87 Assault by pesticides; X88 Assault by gases and vapours; X89 Assault by other specified chemicals and noxious substances; X90 Assault by unspecified chemical or noxious substance; X91 Assault by hanging strangulation and suffocation; X92 Assault by drowning and submersion; X93 Assault by handgun discharge; X94 Assault by rifle shotgun and larger firearm discharge; X95 Assault by other and unspecified firearm discharge; X96 Assault by explosive material; X97 Assault by smoke fire and flames; X98 Assault by steam hot vapours and hot objects; X99 Assault by sharp object; Y00 Assault by blunt object; Y01 Assault by pushing from high place; Y02 Assault by pushing or placing victim before moving object; Y03 Assault by crashing of motor vehicle; Y04 Assault by bodily force; Y05 Sexual assault by bodily force; Y06 Neglect and abandonment; Y07 Other maltreatment syndromes; Y08 Assault by other specified means; Y09 Assault by unspecified means.
6. Definitions Finished admission episodes A finished admission episode is the first period of inpatient care under one consultant within one healthcare provider. Finished admission episodes are counted against the year in which the admission episode finishes. Please note that admissions do not represent the number of inpatients, as a person may have more than one admission within the year. Finished Consultant Episode (FCE) A finished consultant episode (FCE) is defined as a continuous period of admitted patient care under one consultant within one healthcare provider. FCEs are counted against the year in which they end. Please note that the figures do not represent the number of different patients, as a person may have more than one episode of care within the same stay in hospital or in different stays in the same year. Please note an FCE in which the complication was recorded may not necessarily have ended in the same month in which the FCE with which caused the complication took place. Some of the trend relating to the increase in the number of FCEs with a cause code of complications, can be attributed to the general increasing number of FCEs. Trends may also include effects of any changes in data recording and clinical coding practices.
7. For media enquires please call 0845 257 6990 or contact:
   
   - Kristina Fox on 0113 2547120, Kristina.fox@ic.nhs.uk
   - Fraser Woodward on 07983 629448, fraser.woodward@ic.nhs.uk
   - Sarah Dahlgren on 0113 254 7272, sarah.dahlgren@ic.nhs.uk