New health glass for day surgery – still great variety


The Center for Clinical Documentation and Evaluation (SKDE) has launched an updated health certificate on day surgery three years after the first came. The geographical differences are still high, despite the focus in the following years. 

The basic question highlighted in the health threads is whether the health services are equally distributed, regardless of residence. The first Norwegian health class was published on January 13, 2015, giving an overview of twelve of the most common interventions normally performed in Denmark. The health class “Day Surgery 2011-2013” showed great variation for most interventions.
The new health class describes the extent and variability between the healthcare areas’ admission areas for the same twelve interventions during the period 2013-2017. The main data source is the Norwegian  Patient Register containing information on publicly funded activity at public and private hospitals and at appointment specialists.

What has happened since 2013?

The geographical differences revealed by Dagkirurgiatlaset from 2015 received attention both in the academic communities, in the media and from health minister Bent Høie. In spite of this, the variation in the use of day surgical procedures remains high between the health authorities’ areas of admission.
For some interventions, and especially for shoulder surgery, ventricular vents and heavy eyelids, the variation between the recording areas increased.
In general, the extent of day surgery was relatively stable during the period 2013-2017. For the two interventions most discussed, shoulder surgery and intervention on meniscus, the decline in number of interventions has been significant in recent years. For these interventions, there was already a scientific debate on utility, and the decline was commenced before the 2015 Daycare Surgery was launched.
The new day surgery surgery shows a significant increase from 2013 to 2017 in the extent of interventions for hemoroids and heavy eyelids.

Calls for management measures

D agarurgia laser helped to set the variation in the use of health services on the agenda and was followed up in both parliamentary reports and in the mission documents from the Ministry of Health and Care Services to the
regional health authorities. SKDE finds to a small extent that control measures have been taken to reduce variability on the basis of the Dagkirurgiatlaset. In Health South East, efforts to reduce shoulder and menstrual surgery started before publication. In Helse Vest, the academic communities were invited to choose from a range of patient committees, interventions and indicators that showed variation with the purpose of establishing measures to reduce the variation, but none of the projects initiated in the health enterprises were aimed at day surgical procedures. Following the publication of the Dagkirurgiatlaset, Helse Midt-Norge has monitored developments  in the use of day surgical procedures and used the information in dialogue with its health enterprises, private hospitals and appointment specialists.
There are some examples that the health and safety environment in different health enterprises has changed practice after the variation became known. It seems that changes in practice have come first and foremost on the basis of professional discussions nationally or locally.

Encourages wise choices

It has now been three years since the first Dagkirurgiatlaset was published and the variation in the use of health services came on the national health policy agenda. Changes take time. The results of the atlas are used to a greater extent now than before, including in the regional health authorities’ planning work.
The Doctors’ Campaign “Make Wise Choices!” Represents an important program for discussing utility value through various investigations and treatments. This can also be a constructive approach to more systematic work to reduce unjustified variation in health services.
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