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The Office of the Auditor General's investigation of efficiency in hospitals

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Summary

Background and objective of the audit

An efficient specialist health service is an important element in providing the public with equal and good health services. In 2011 the operating expenses of the specialist health service totalled approximately NOK 109 billion. There are large productivity differences between the health trusts, and little information about why this is so.

The objective of the audit has been to assess whether it is possible to streamline the organisation of patient treatment by the hospitals. Differences in productivity have been calculated on the basis of data on four forms of treatment, and investigations were carried out to identify factors that can provide shorter hospital stays, efficient courses of treatment and high utilisation of operating rooms. The audit covers the period 2009–2013.

Findings and recommendations

The hospitals can become more efficient

There are wide variations between the hospitals as regards length of stay for the same form of treatment.

It varies among the hospitals whether cruciate ligament patients who are operated on have to spend the night or not

Hospitals with short stays do not have a higher number of patients who are readmitted or die following surgery

Better utilisation of operating rooms can reduce health queues.

The Office of the Auditor General (OAG) recommends that the Ministry of Health and Care Services and the regional health authorities ensure that hospitals with efficient courses of treatment and high utilisation of operating rooms transfer their experiences to other hospitals.

Inter-disciplinary and standardised courses of treatment provide efficient operations

Many hospitals have achieved shorter stays with inter-disciplinary and systematic courses of treatment. The practice has removed unnecessary routines and bottlenecks, and created a clearer division of tasks and more predictability for those treating the patient.

The OAG recommends that the health trusts establish standardised inter-disciplinary courses of treatment for major groups of patients.

Better utilisation of the operating rooms can reduce health queues

In many hospitals, the capacity of operating rooms represents the main bottleneck in being able to treat more patients.

There is wide variation between the hospitals as to when the first operation of the day starts, how much time elapses between operations and when the last operation of the day is finished.

The OAG recommends that the health trusts take a closer look at how to utilise the capacity of the operating rooms.

The quality indicator for hip fractures creates uncertainty about good practice

How long patients with broken hips must stay in the hospital before surgery varies considerably among the hospitals.

To ensure equal treatment and correct prioritisation of operating capacity, the OAG recommends that the Ministry of Health and Care Services clarify what is good professional practice for how soon patients with broken hips should be operated on.

The use of rehabilitation institutions varies considerably

At many hospitals, hip replacement patients spent an average of approximately two weeks at a rehabilitation institution following their hospital stay.

Many hospitals with short stays that send few hip replacement patients to rehabilitation institutions after surgery do not have poorer treatment results than other hospitals.

The OAG recommends that the regional health authorities consider whether the scope of the use of rehabilitation institutions for hip replacement patients can be justified in terms of health economics.

Ministry/ministries:

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