The results give support to the assumption of a link between hospital operating conditions and patient outcome.

High patient turnover at the discharging ward was found to increase the patients' hazard of early readmission. This observation supports the hypothesis of a link between the operation conditions of the hospitals and patient outcome on a short time-scale.

BackgroundIntermediate care is intended to reduce hospital admissions and facilitate early discharge. In Norway, a model was developed with transfer to intermediate care shortly after hospital admission. Efficacy and safety of this model have not been studied previously.In a parallel-group randomized controlled trial, patients over 70 years living at home before admission were eligible if clinically stable, without need for surgical treatment and deemed suited for intermediate care by attending physician. Intervention group patients were transferred to a nursing home unit with increased staff and multidisciplinary assessment, for a maximum stay of three weeks. Patients in the control group received usual care in hospital. Blinding to group assignment was not possible.The primary outcome was number of days living at home in a follow-up period of 365 days. Secondary outcomes were mortality, hospital admissions, need for residential care and home care services. Data were obtained from patient records and registers.Results376 patients were included, 74 % female and mean age 84 years. There was no significant differences between intervention (n = 190) and control group (n = 186) for number of days living at home (253.7 vs 256.5, p = 0.80) or days in hospital (10.4 vs 10.5, p = 0.748). Intervention group patients spent less time in nursing home (40.6 days vs. 55.0, p = 0.046), and more patients lived independently without home health care services (31.6 % vs 19.9 %, p = 0.007).For orthopaedic patients (n = 128), mortality was higher in the intervention group; 15 intervention patients and 7 controls died (25.1 % vs 10.3 %, p = 0.049). There was no significant difference in one-year mortality for medical patients (n = 150) or the total study population.ConclusionsThis model of rapid transfer to intermediate care did not significantly influence number of days living at home during one year follow-up, but reduced demand for nursing home care and need for home health care services. In post-hoc analysis mortality was increased for orthopedic patients.Trial registrationThe trial was registered 26. July 2013 at Current Controlled Trials and assigned with registration number ISRCTN21608185.

When unplanned readmissions are used as an outcome indicator, the measure is susceptible to the choice of time interval. The operative characteristics must be interpreted in the context of where it is intended that the indicator should be used.

Background: Different strategies for addressing the challenge of prioritizing elective patients efficiently and fairly have been introduced in Norway. In the time period studied, there were three possible outcomes for elective patients that had been through the process of priority setting: (i) high priority with assigned individual maximum waiting time; (ii) low priority without a maximum waiting time; and (iii) refusal (not in need for specialized services). We study variation in priority status and waiting time of the first two groups across different medical disciplines. Methods: Data was extracted from the Norwegian Patient Register (NPR) and contains information on elective referrals to 41 hospitals in the Western Norway Regional Health Authority in 2010. The hospital practice across different specialties was measured by patient priority status and waiting times. The distributions of assigned maximum waiting times and the actual ones were analyzed using standard Kernel density estimation. The perspective of the planning process was studied by measuring the time interval between the actual start of healthcare and the maximum waiting time. Results: Considerable variation was found across medical specialties concerning proportion of priority patients and their maximum waiting times. The degree of differentiation in terms of maximum waiting times also varied by medical discipline. We found that the actual waiting time was very close to the assigned maximum waiting time. Furthermore, there was no clear correspondence between the actual waiting time for patients and their priority status. Conclusion: Variations across medical disciplines are often interpreted as differences in clinical judgment and capacity. Alternatively they primarily reflect differences in patient characteristics, patient case-mix, as well as capacity. One hypothesis for further research is that the introduction of maximum waiting times may have contributed to push the actual waiting time towards the maximum. The finding that the actual waiting time was very close to the maximum waiting time supports this. The lack of clear correspondence between the actual waiting time for patients and their priority status may imply that urgency, described in the referral letter, and severity of illness, according to guidelines, are two separate entities. Keywords: Waiting Lists, Prioritization, Healthcare Sector Copyright: © 2016 by Kerman University of Medical Sciences Citation: Gangstøe JJ, Heggestad T, Norheim OF. Norwegian priority setting in practice -an analysis of waiting time patterns across medical disciplines.