Variability in elective day-surgery rates between Belgian hospitals - Analyses of administrative data explained by surgical experts. (September 2017)

• Record Type: Journal Article
• Authors: Leroy, Roos; Camberlin, Cécile; Lefèvre, Mélanie; Van den Heede, Koen; Van de Voorde, Carine; Beguin, Claire
• Is Part Of: International journal of surgery. Volume 45(2017)
• Page Start: 118
• Page End: 124
• Publication Date: 2017-09
• Subjects: Day surgery -- Elective surgery -- Variability in care delivery -- Benchmarking -- Monitoring; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2017.07.075
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Background: In the last decades, day surgery has steadily and significantly grown in many countries, yet the increase has been uneven. There are large variations in day-surgery activity between countries, but also within countries between hospitals and surgeons. This paper explores the variability in day-care activity for elective surgical procedures between Belgian hospitals. Materials and methods: The administrative hospital data of all patients formally admitted in a Belgian hospital for inpatient or day-care surgery between 2011 and 2013 were analysed and summarized in graphs. During 11 expert meetings with ad-hoc surgical expert groups the variability in day-surgery share between hospitals was discussed in depth. Results: The variability in day-care share between Belgian hospitals is considerable. For 37 out of 486 elective surgical procedures, the variability ranged between 0 and 100%. High national day-care rates do not preclude room for improvement for certain hospitals as for the majority of these procedures there are "low performers". According to the consulted clinical experts, the high variability in day-care share may for the greater part be explained by medical team related factors, customs and traditions, the lack of clinical guidelines, financial factors, organisational factors and patient related factors. Conclusion: If a further expansion of day surgery is envisaged in Belgium the factors that contribute to the current variability in day-surgery rates between hospitals should be addressed. In addition, a feedback system in which hospitals and health care providers have the figures on their percentage of procedures carried out in day surgery compared to other hospitals and care providers (benchmarking) and the monitoring of a number of quality indicators (e.g. unplanned readmission, unplanned inpatient stay, emergency department visit) should be installed. Highlights: The variability in day-surgery rates between Belgian hospitals is considerable. Also for procedures with high national day-care rates there are some hospitals with low day-care rates. Medical team related factors, financial, organisational and patient related factors contribute to the high variability. Policies towards more day surgery in Belgium should also include benchmarking and the monitoring of quality indicators.