The Mental Health Inpatient and Day Case dataset (SMR04) collects episode level data on patients who are receiving care at psychiatric hospitals at the point of both admission and discharge.
This is a subset of data for the Brain Health Data Pilot (BHDP).

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The Brain Health Data Pilot (BHDP) project aims to be a shared database (like a library) of information for scientists studying brain health, especially for diseases like dementia, which affects about 900,000 people in the UK. Its main feature is a huge collection of brain images linked to routinely collected health records, both from NHS Scotland, which will help scientists learn more about dementia and other brain diseases. What is special about this database is that it will get better over time – as scientists use it and add their discoveries, it becomes more valuable. 

This is a subset of the Mental Health Inpatient and Day Case - Scottish Morbidity Record (SMR04) dataset for use in the Brain Health Data Pilot (BHDP) project. 

The dataset contains a wide variety of information such as patient characteristics, mental health diagnosis, length of stay, destination on discharge, whether they are admitted under Mental Health Legislation and any previous psychiatric care. Patient identifiers such as name, date of birth, Community Health Index number, NHS number, and postcode are included together with a wide variety of geographical measures. This includes the Scottish Index of Multiple Deprivation and Carstairs measures, census output area, NHS Board, Electoral Ward and Parliamentary constituency.

HDR UK

National Services Scotland;,;Public Health Scotland

Format
Date (ddmmyy)

Field Length
6

Priority
Mandatory

Definition
Admission Date is the date on which an inpatient or day case admission occurs.

Recording Rules
The full date should be entered thus: 2 December 2004=
0	2	1	2	0	4
Points to Note
None.

Cross Checks

Date of Admission is checked to be in sequence with the other dates recorded.
The Patient’s Age is calculated between Date of Birth and Date of Admission, and is used in cross-checks with:
* Specialty
* Diagnosis
Duration of Stay (Stay) is calculated as the time between Date of Admission and Date of Discharge, and is used in cross-checks involving
* Management of Patient
* Significant Facility
* Diagnosis
SMR01 and SMR50 - Waiting Time (Wait) is calculated as the time between Date Placed on Waiting List (when present) and Date of Admission, and is used in cross-checks involving all the Diagnoses recorded.
SMR01 and SMR11 - If Admission Date equals Date of Birth and the Significant Facility is not 11 (Other), 12 (Postnatal Cot), 15 (Neonatal Unit) or 16 (Childrens Unit), the record will always be queried.
SMR02,SMR04 and SMR50 - Admission Date must not equal Date of Birth.
Admission Date is checked against Waiting List Date and, if both dates are the same, the record is queried.
SMR Validation - Admission-Date


Related items:

Day Case Admission
Inpatient Admission
Tags:
inpatient  day  case  sequence  SMR01  SMR02  SMR04

Admission Date

Episode Management Data

Format
Characters

Field Length
3

Priority
Mandatory

Definitions

Specialty
A Specialty is defined as a division of medicine or dentistry covering a specific area of clinical activity and identified within one of the Royal Colleges or Faculties.

Click here for a complete list of Specialties

Discipline
A Discipline is a non-medical profession related to healthcare, for which a formal training leading to a recognised professional qualification is undertaken. Examples of disciplines are physiotherapy, nursing, pharmacology.

Recording Rules
This field should be coded to the Specialty/Discipline of the consultant/GP/HCP who is in charge of the patient episode. If the consultant is formally recognised and contracted to work in more than one specialty then the patients problem or condition should dictate the specialty.

Note that this is the ONLY rule for completing this field. The designation of the beds is not used.

Specialty/Discipline comprises four characters, the first three of which are allocated by ISD for each specialty, and is mandatory for completion. For the majority of Specialty/Discipline codes, which are two characters, the 3rd character space must be left blank if the 4th character extension is used. The 4th character is an Optional extension of the code for local special interests.

The Specialty/Discipline code should be entered in the character spaces provided and left justified.

Points to Note

A separate SMR record is prepared when a patient changes Specialty, Significant Facility or Consultant on medical grounds
GPs: Patients under the care of a GP in a GP hospital must be given the Specialty code E12 (GP other than Obstetrics) regardless of whether the patients are in a short stay or long stay facility.
Staff Wards: The Specialty recorded is that of the consultant/GP in charge of the patient. Record Significant Facility as 11 (Other: including all Standard Specialty Wards, Clinical Facility 1K, Day Bed Unit 1J).
Younger Physically Disabled: Record the Specialty of the consultant in charge of the patient, which will usually be geriatric medicine. Record Significant Facility as 18 (Ward for Younger Physically Disabled) or 1E (Long Stay Unit for Care of the Elderly).
See additional notes under Significant Facility.
For SMR02 records this should reflect the speciality of the person who was responsible for the care for the mother on original admission.
Example 1- If the mother was originally admitted under the care of a midwife in an Alongside Midwifery Unit (AMU) or Freestanding Midwifery Unit (FMU), then the midwifery specialty should be recorded in this section, irrespective of whether the mother was then transferred to an Obstetric unit during labour/delivery. When a transfer has occurred Speciality should NOT be attributed to Obstetrics.

Example 2 - If the mother was originally admitted under the care of a Consultant in an Obstetric Unit then the Obstetrics specialty should be recorded here.

Cross Checks

Specialty is checked against Location Code.
Specialty is checked against Consultant.
Specialty is checked against the Patients Age (at Date of Admission).
Specialty is checked against Duration of Stay calculated between Date of Admission and Date of Discharge.
Specialty is checked against Record Type
Specialty is checked against Significant Facility.
SMR Validation - Specialty/Discipline


Related items:

HCP Responsible for Care
Location Code
Significant Facility
SMR Record Type
Tags:
division  medicine  dentistry  clinical  activity  royal  college  faculties  consultant  GP  HCP  patient  episode  alongside  midwifery  unit  AMU  freestanding  FMU  SMR00  SMR01  SMR02  SMR04

Specialty/Discipline

Format
Characters

Field Length
6
Priority
Mandatory

Definition
This item should be seen as describing the main medical (or social) condition managed/investigated during the patients stay.

Recording Rules
The main condition is the condition, diagnosed at the end of the episode of health care, primarily responsible for the patients need for treatment or investigation. If there is more than one such condition, the one held most responsible for the greatest use of resources should be selected. If no diagnosis was made, the main symptom, abnormal finding, or problem should be selected as the main condition.

Points to Note

For patients who have died, the main condition is not necessarily the same as the condition recorded as the cause of death.
The main condition should be decided by a senior member of the medical staff and recorded in the agreed place in the case notes, on the appropriate form or computer system.
If the main condition is coded to a pair of dagger and asterisk codes, the dagger should be entered as main condition.
If the main condition is an injury or other condition due to an external cause, the injury or condition should be entered as main condition with the external cause code following the injury (or injuries).
In the case of the admission record for SMR04 the admission diagnosis would be as defined in the recording rules (but as diagnosed at the beginning of the episode of healthcare). Further guidance is given in the SMR04 section of the electronic data manual.
Cross Checks

A check is made that each Diagnosis Code is valid as defined by the ICD classification. If not, an error will be reported.
A check is made that the use of the code (although listed in the ICD Classification) is actually permitted on the record type. If a discrepancy is found, an appropriate error or query will be reported.
Main condition is cross-checked against:
Sex
Age (except SMR02)
Rarity (except SMR00, and SMR02)
Admission Type (SMR01)
Length of Stay (SMR01 and SMR04)
Waiting Time (SMR01 only)
Discharge Type (SMR01)
Condition on Discharge (SMR02 only)
SMR Validation - Main Condition

Tags:
medical  social  managed  investigated  patient  stay  diagnosed  treatment  ICD10  classification  code  SMR00  SMR01  SMR02  SMR04

Main Condition/Principal Diagnosis/Problem Managed - ICD10

General Clinical Information

Format
Characters

Field Length
6

Priority
Local

Definition
In addition to the main condition, the record should, whenever possible, also list separately other conditions or problems dealt with during the episode of health care. Other conditions are defined as those conditions that co-exist or develop during the episode of healthcare and affect the management of the patient. Conditions related to an earlier episode that have no bearing on the current episode should not be recorded.

For further information on co-morbidities and other conditions, please refer to the Scottish Clinical Coding Standards, (in particular Coding Guidelines 21 November 2007) as held on the Terminology Website

Points to Note

Up to five other significant conditions may be recorded for SMR01 returns.
Other conditions should be recorded according to the rules outlined in Coding Guidelines 21 November 2007.
From April 2020,this data item is no longer required for national collection on SMR00, though may still be collected locally.
Priority changed from Mandatory (where applicable) to Local.
Cross Checks

As for main condition.
A main condition must be recorded before the Other Condition fields can be completed.
SMR Validation - Other Conditions

Tags:
addition  main  episode  problem  management  patient  coding  guidelines  care  significant  ICD10  SMR00  SMR01  SMR02  SMR04

Other Condition/Co-morbidity and Complication ICD10 1

Other Condition/Co-morbidity and Complication ICD10 2

Other Condition/Co-morbidity and Complication ICD10 3

Other Condition/Co-morbidity and Complication ICD10 4

Other Condition/Co-morbidity and Complication ICD10 5

Format
Characters

Field Length
8

Priority
Conditional

Definition
Main Operation/Treatment/Investigative Procedure/Intervention are those aspects of clinical care carried out on patients undergoing treatment:

for the prevention, diagnosis, care or relief of disease
for the correction of deformity or deficit, including those performed for cosmetic reasons
associated with pregnancy, childbirth or contraceptive or procreative management
Typically this will be:

surgical in nature: and/or
carries a procedural risk: and/or
carries an anaesthetic risk: and/or
requires specialist training: and/or
requires special facilities or equipment only available in an acute care setting.
Points to Note

Please refer to the general rules for recording operations/procedures.
Cross Checks

A check is made that each Operation Code is valid as defined by the OPCS Classification. If not, an error will be reported.
A check is made that the use of the OPCS code is actually permitted on the record type. If a discrepancy is found, an appropriate error or query will be reported.
If Main Operation is specified, but the Date of Main Operation is not given, an error will be reported.
Each operation can have one or two codes. Checks are made to ensure that an Approach, Technique, Site or Laterality code is not supplied on its own or with another such code. If it is an error will be reported.

SMR01
If a code is recorded in the second field of a pair as well as the first field, checks are made to ensure that either:
the two codes are a recognised pair or
the code in the second field is from one of the subsidiary Y or Z chapters.
For any two consecutive single-coded operations, a check is made to see if these could be combined as one dual-coded operation. If this is possible, a query is reported.
If the patient is a Day Case, a further check will be made on each Operation code to ensure that the Operation is appropriate for such cases. If not, an error or query will be reported.
If the patient is an Outpatient, a further check will be made on each Operation code to ensure that the Operation is appropriate for such cases. If not, a query will be reported.
Each Operation code is checked to ensure that it is compatible with the stated Sex.
If a discrepancy is found an error or a query will be reported.
SMR Validation - Main and Other Operation/Treatment/Investigative Procedure

Tags:
clinical  care  patients  code  classification  undergoing  treatment  surgical  anaesthetic  acute  SMR00  SMR01  SMR02  SMR04

Main Operation/Treatment/Investigative Procedure/Intervention - OPCS4

Format
Characters

Field Length
8

Priority
Conditional

Definition
These are the additional procedures performed on an individual patient at a particular time.

Points to Note

Up to three pairs of procedures, in addition to the main procedure, may be recorded for an inpatient or day case episode on the central return. Therefore, if more than four procedures are performed during an episode of care, the clinicians opinion should be sought on which are the most significant. Local systems may allow more than four procedures to be recorded.
Cross Checks

These are detailed in Main Operation/Treatment/Investigative Procedure/Intervention.
SMR Validation - Other Operation

Tags:
additional  patient  inpatient  day  case  episode  performed  SMR00  SMR01  SMR02  SMR04

Other Operation/Treatment/Intervention/Investigative Procedures - OPCS4 1

Other Operation/Treatment/Intervention/Investigative Procedures - OPCS4 2

Other Operation/Treatment/Intervention/Investigative Procedures - OPCS4 3

Format
Date (ddmmyy)

Field Length
6

Priority
Conditional

Definition
This reflects the date the main operation was performed.

Recording Rules
The full date should be entered thus: 5 July 2004 = 05/07/04

Cross Checks

Date of Main Operation is checked to ensure it is in the correct sequence with other dates recorded.
An error will be reported if there is a Main Operation recorded but the Date of Main Operation has been omitted.
An error will be reported if an entry has been made for Date of Main Operation, but the Main Operation has been omitted.
SMR Validation - Date of Main Operation/Treatment/Investigative Procedure

Tags:
sequence  reported  performed  SMR00  SMR01  SMR02  SMR04

Date of Main Operation/Treatment/Investigative Procedure/Intervention

Format
Date (ddmmyy)

Field Length
6

Priority
Conditional

Definition
This reflects the date the other operation was performed.

Recording Rules
The full date should be entered thus: 5 July 2004 = 05/07/04

Cross Checks

Date of Other Operation is checked to ensure it is in the correct sequence with other dates recorded.
SMR Validation - Date of Other Operation

Tags:
performed  sequence  recorded  SMR00  SMR01  SMR02  SMR04

Date of Other Operation/Treatment/Intervention/Investigative Procedures 1

Date of Other Operation/Treatment/Intervention/Investigative Procedures 2

Date of Other Operation/Treatment/Intervention/Investigative Procedures 3

Field Length
6

Priority
Mandatory (where applicable)

Definition
The main medical problem which the patient is experiencing at the time of admission.

Points to Note

For detailed instructions on ICD10 coding please refer to General Clinical Section.
Main condition should come from the ICD10 Chapter V (Mental and Behavioural Disorders), or selected Z codes from Chapter XXI (Factors influencing health status and contact with health services).
Main condition is Optional on Admission submissions and Mandatory on Discharge submissions.
Cross Checks

The ICD10 codes recorded must be valid codes and in the correct format.
Any ICD10 codes other than those from Chapter V and selected Z codes from Chapter XXI will be queried or errored.
The ICD10 codes are checked against Sex and Age on Admission.
SMR Validation - Admission - Main Condition/Principal Diagnosis/Problem Managed

Tags:
medical  problem  admission  patient  ICD10  SMR04

Main Cond/Principal Diag/Problem Managed - SMR04

An SMR04 is generated for patients receiving care in Mental Health Specialties when the following events occur. Part 1 of the record containing admission details is completed and submitted; on discharge Part 2 is completed and submitted.

Inpatients and Day Cases are admitted to NHS hospitals from locations external to the NHS.
Inpatients and Day Cases are admitted to contracted NHS beds in non-NHS institutions.
Inpatients and Day Cases change specialty (with or without a change of consultant):
An inpatient transfers to become an Inpatient in another specialty in the same hospital
An inpatient becomes a Day Case in another specialty during the inpatient stay
A day case transfers to become an Inpatient in another specialty (except when the day case episode during an inpatient stay and the patient is transferring back to the original consultant)
A day case transfers back to resume an Inpatient stay but DOES NOT transfer back to the original consultant for medical reasons
Inpatients and Day Cases transfer from another NHS hospital (including contracted NHS beds in non-NHS institutions).
Inpatients and Day Cases change consultant for medical reasons within the same specialty:
An inpatient transfers as an Inpatient to the care of a different consultant for medical reasons in the same specialty in the same hospital
An inpatient becomes a Day Case in the same specialty under a different consultant for medical reasons during the inpatient stay
A day case transfers to become an Inpatient under the care of a different consultant in the same specialty for medical reasons (except when the day case episode is during an inpatient stay and the patient is transferring back to the original consultant)
A day case transfers back to resume an Inpatient stay in the same specialty but DOES NOT transfer back to the original consultant for medical reasons
Inpatients move into and/or out of one of the significant facilities listed in this section.
Note: The General Definition of Psychiatric is now referred to as Mental Health.

Mental Health Inpatient and Day Case

Field Length
6

Priority
Conditional

Definition
Other medical conditions which contributed to the decision to admit the patient or which were identified on admission as requiring management.

Points to Note

For detailed instructions on ICD10 coding please refer to General Clinical Section.
For specific instructions relating to Psychiatric conditions please refer to the Diagnostic Section.
Cross Checks

The ICD10 codes recorded must be valid codes and in the correct format.
There must be an entry in Main condition if any of the Other conditions fields are completed.
The ICD10 codes are checked against Sex and Age on Admission.
SMR Validation - Admission - Other Conditions/Co-morbidity and Complications


Related items:

Main Condition/Principal Diagnosis/Problem Managed - SMR04
Tags:
medical  condition  patient  management  ICD10  diagnostic  admission  SMR04

Other Conditions/Comorbidity & Complications - SMR04 2

Other Conditions/Comorbidity & Complications - SMR04 3

Other Conditions/Comorbidity & Complications - SMR04 4

Format
Integer

Field Length
1

Priority
Local

Definition
A categorisation which divides the Scottish population into five equal categories based on the range of SIMD scores so that 20% of the population falls into each quintile (population weighted).

Points to note

For SIMD2016
Most Deprived Quintile = 1
Least Deprived Quintile = 5

SIMD Scotland Quintile

The index is an area based measure, calculated at data zone level and has seven domains (income, employment, education, housing, health, crime and geographical access). These have been combined into an overall index. Please note that SIMD values may appear for records prior to 1999, however ISD recommendations are to use SIMD for trend analyses from 1999 onwards. For trend analyses back to 1991, use the 2001 census based Carstairs deprivation.
For trend analyses back to before 1991, use the 1991 census based Carstairs deprivation. See the ISD website for further information.
Please indicate which SIMD version you would like for each selected variable.
 
Note on change in ordering of quintiles and deciles
Following the release of the SIMD 2009, ISD changed their ordering of quintiles and deciles to fit with the method that is used by the Scottish Government
(SG). For SIMD 2009, SIMD 2012 and future releases, the method is now: 1 = MOST deprived, 5 or 10 = LEAST deprived
 
 ISD analyses based on SIMD 2006 or SIMD 2004 will be left in their current format:  1 = LEAST deprived; 5 or 10 = MOST deprived.
To avoid confusion, deprivation categories should always be fully labelled. For example, for SIMD 2012, 'decile 1 (most deprived)'… 'decile 10 (least deprived)'.
For time trend analyses combining SIMD 2004/2006 with SIMD 2009/2012 it is important to treat all deciles and quintiles in the same way. SIMD 2004/2006 deciles/quintiles should be reversed from 1=LEAST deprived, 5 or 10=MOST deprived to 1=MOST deprived, 5 or 10=LEAST deprived in order to keep the same convention for the deciles and quintiles throughout the analysis.

Scottish Index of Multiple Deprivation (SIMD)

BHDP - Mental Health Inpatient and Day Case - Scottish Morbidity Record (SMR04)

The index is an area based measure, calculated at data zone level and has seven domains (income, employment, education, housing, health, crime and geographical access). These have been combined into an overall index. Please note that SIMD values may appear for records prior to 1999, however ISD recommendations are to use SIMD for trend analyses from 1999 onwards. For trend analyses back to 1991, use the 2001 census based Carstairs deprivation.
For trend analyses back to before 1991, use the 1991 census based Carstairs deprivation. See the ISD website for further information.
Please indicate which SIMD version you would like for each selected variable.
 
Note on change in ordering of quintiles and deciles
Following the release of the SIMD 2009, ISD changed their ordering of quintiles and deciles to fit with the method that is used by the Scottish Government
(SG). For SIMD 2009, SIMD 2012 and future releases, the method is now: 1 = MOST deprived, 5 or 10 = LEAST deprived
 
 ISD analyses based on SIMD 2006 or SIMD 2004 will be left in their current format:  1 = LEAST deprived; 5 or 10 = MOST deprived.
To avoid confusion, deprivation categories should always be fully labelled. For example, for SIMD 2012, "decile 1 (most deprived)"… "decile 10 (least deprived)".
For time trend analyses combining SIMD 2004/2006 with SIMD 2009/2012 it is important to treat all deciles and quintiles in the same way. SIMD 2004/2006 deciles/quintiles should be reversed from 1=LEAST deprived, 5 or 10=MOST deprived to 1=MOST deprived, 5 or 10=LEAST deprived in order to keep the same convention for the deciles and quintiles throughout the analysis.

BHDP - Mental Health Inpatient and Day Case - Scottish Morbidity Record (SMR04)

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