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Many hospitals can streamline patient treatment by learning from others

Patient treatment can be more efficient with solutions from hospitals with short stays, efficient courses of treatment and high utilisation of operating rooms. - Many hospitals can increase their efficiency by learning from others, and the Ministry of Health and Care Services should ensure that this takes place more systematically, says Auditor General Jørgen Kosmo.
Published 11/28/2013 12:00 PM

Document 3:4 (2013–2014) The OAG's investigation of efficiency in hospitals was submitted to the Storting on 28 November 2013.

The Storting's appropriations to the specialist health service totals approximately NOK 110 billion. On the basis of four forms of treatment it was assessed whether it is possible to organise patient treatment more efficiently at the hospitals.

Most hospitals do not have information showing what it costs to treat a patient or group of patients. The OAG's audit has consequently used average hospital stays as an indicator of the use of resources in the forms of treatment. Because hospital stays generate such a substantial share of the costs of treating patients, they indicate whether there are substantial efficiency differences among the hospitals.

The audit shows that the average stay varies among the hospitals from

  • three to eleven days for hip replacement surgery
  • five to ten days for hip fracture surgery
  • zero to four days for cruciate ligament surgery
  • seven to eleven days for colon cancer surgery.

If all hospitals had had an average stay at the same level as the hospital with the shortest stays, the number of bed days could be reduced each year by around

  • 14 000 bed days for hip replacement surgery (34 per cent)
  • 11 000 bed days for hip fracture surgery (19 per cent)
  • 1 400 bed days for cruciate ligament surgery (100 per cent)
  • 3 900 bed days for colon cancer surgery (24 per cent)

- The freed-up capacity could have been used to treat more patients, says Kosmo.

The audit shows that the quality of patient treatment at hospitals with short stays is the same as at hospitals with longer stays.

- There is no clear difference between hospitals with short and long stays in the percentage of patients who are readmitted, reoperated or die over the course of one year after the operation. The functional level of the patients is also the same one year after the operation. In other words, the reduction in hospital stays has not been at the expense of treatment quality, Kosmo concludes.

The capacity of the operating rooms is the main bottleneck in being able to operate on more patients. The audit shows considerable variation in the degree to which the hospitals utilise the capacity of their operating rooms. In half of the operating rooms surveyed, the first patient is wheeled in after 08.30, and in half of the operating rooms the last operation of the day is finished before 14.30.

- Many patients could have had shorter waiting times for treatment if all hospitals had utilised their operating room capacity as well as the best, Kosmo points out.

The hospitals that best utilise operating rooms actively use management data to set up surgery schedules that provide good use of resources. The audit also shows more examples of hospitals that have achieved shorter stays by developing efficient courses of treatment. Unnecessary routines and bottlenecks have been removed, creating clearer divisions of tasks and more predictability for medical professionals who treat patients. As a result, the course of treatment across hospital units has become more coordinated and marked by continuity. The OAG notes that the course of treatment for many other patient groups also has similarities with how this is organised for the four groups that were studied.

- This suggests that the measures we have found examples of here can significantly streamline the specialist health service, thereby reducing health queues, says Kosmo.

In his response to the OAG, the Minister of Health and Care Services points to several differences in the courses of treatment and utilisation of resources between health authorities and hospitals, and that the Ministry will ensure that the specialist health service will become familiar with and learn from this.

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