Norwegian Hospitals Research Articles

Screening and Following Up Harmful Alcohol Use “… is Not Necessarily Your Primary Focus”: A Qualitative Study Exploring Health Professionals’ Experiences Addressing Harmful Alcohol Use in a Norwegian Hospital

Screening and Following Up Harmful Alcohol Use “… is Not Necessarily Your Primary Focus”: A Qualitative Study Exploring Health Professionals’ Experiences Addressing Harmful Alcohol Use in a Norwegian Hospital

Time trends in mortality, incidence and case-fatality of acute myocardial infarction in Norway - do we see the end of the coronary heart disease epidemic?

Abstract Background In Norway and most industrialized countries the mortality rates from acute myocardial infarction (AMI) increased after World War II, peaked in the 1960s – 1970s, and have since that time declined (Figure). Recent studies have suggested that the decline may have leveled off, and that the favourable trends do not include younger age groups, possibly due obesity and diabetes. Also, the relative contribution of a reduction in incidence and improved case-fatality rates (CFR) to the AMI mortality trends are not known with certainty. We examined mortality trends of AMI in Norway during 1951 – 2021, and the incidence and CFR of hospitalized and non-hospitalized AMI during 2013-2021. Methods Fatal AMI cases were identified in the National Causes of Death Registry. Norwegian hospitals are required by law to register all patients hospitalized for AMI in the Norwegian AMI Registry. Hospitalized cases not registered in the AMI registry were retrieved from the Norwegian Patient Registry which contains discharge diagnoses for hospitalized patients. The national unique 11-digit identification number allowed linkage of the registries and identification of transfers between hospitals and re-hospitalizations. An AMI (either hospitalization or death) was classified as incident if no hospitalization was found for that individual during the previous 5 years. We calculated age-adjusted rates with the Norwegian population in 2017 as standard. Results Norwegian AMI mortality rates increased from 1951, peaked in the late 1960s, and have since that time declined steadily, although steeper after around 1990 (Figure). Present AMI mortality rates are lower than in the 1950s, and are still declining. Incidence of AMI (hospitalized and non-hospitalized) fell from 391/100 000 in 2013 to 271/100 000 in 2021, corresponding to a mean reduction of 3.6 % per year (p<0.001). Incidence of out-of-hospital fatal AMI fell by 6.5 % per year, incidence of hospitalized ST-segment elevation AMI (STEMI) fell by 2.3 % per year, and incidence of non-ST-segment elevation AMI (NSTEMI) fell by 3.1 % per year (all p<0.001). 30-days CFR of hospitalized and non-hospitalized AMI fell from 21.3 % in 2013 to 17.5 % (3.6 % per year; p<0.001). CFR after NSTEMI fell from 8.2 % in 2013 to 6.4 % in 2021 (4.4 % per year; p<0.001), whereas there was no significant change in CFR after STEMI (13.3 % in 2013 and 12.0 % in 2021). The incidence and CFR trends were similar in men and women aged 20-49, 50-79 and 80+ years. Comments Declining incidence of out-of-hospital fatal AMI and declining incidence of hospitalized STEMI and NSTEMI were major contributors to the declining AMI mortality rates in Norway. Improved case-fatality rates among hospitalized patients have contributed to the declining mortality rates, but there was no improvement in case-fatality in STEMI during 2013-2021.

Open and opaque? The performativity of open priorities in a Norwegian hospital

Being open about priority-setting decisions is a central element of frameworks enhancing procedural fairness. While challenges in implementing priority-setting frameworks in general have been reported, few studies have empirically examined how the concept of openness is understood and enacted in the day-to-day functioning of hospitals. This paper explores the operationalisation of the policy of “open priorities”, based on long-term ethnographic fieldwork in a Norwegian hospital in 2022. Drawing on the concept of performativity, the study portrays how the ideal of open priorities translates into everyday practices related to why, for whom and which priorities are to be open. The paper shows how openness was portrayed as a central hospital policy, but was also seen as a source of conflicts, hindering effective governance and reducing public trust. Hence, hospital leaders transformed and diluted the ideal of openness into priority-setting decisions with multiple shields of opaqueness. Through omissions and rewritings of the notion of openness, health leaders enacted performativity. The paper adds to the growing body of knowledge of the multifaceted ways policy ideals are transformed by government institutions in the process of implementation and calls for further exploration of efforts to improve everyday and routinised procedural fairness.

Mental health and health-related quality of life in adolescents surgically treated for hypospadias in childhood

BackgroundThere is limited research and conflicting results on the mental health and health-related quality of life of individuals surgically treated for hypospadias in childhood. Furthermore, the significance of patient-reported outcomes (PRO) in hypospadias is growing. More research is necessary on these topics, particularly in adolescents. ObjectiveWe aimed to compare mental health, health-related quality of life, body satisfaction, self-esteem, penile appearance, and sexual function outcomes in 16-year-old adolescents who had surgery for hypospadias in childhood with a healthy comparison group. Study designThe study involved 16-year-old adolescents who had surgery for hypospadias in one Norwegian hospital. An age-matched comparison group of healthy adolescents was previously recruited. The study assessed self-reported outcomes on mental health using the Strengths and Difficulties Questionnaire, health-related quality of life using the Pediatric Quality of Life Inventory, body satisfaction and self-esteem using the Self-Perception Profile for Adolescents, and genital perception and sexual function using the Pediatric Penile Perception Score and a non-validated structured interview. ResultsIn total, 117 adolescents operated for hypospadias and 61 healthy adolescents were included. The outcomes for mental health and health-related quality of life were not statistically different between groups. However, 18 (16%) hypospadias patients were classified as cases/borderline on mental health outcomes, compared to 2 (3%) in the comparison group (p=0.01). Patients classified as cases/borderline on mental health reported lower health-related quality of life, self-esteem, and more stressful life events. Self-reported penile appearance and sexual function were comparable between groups, however the proximal hypospadias group displayed lower satisfaction. DiscussionAlthough the present study had generally positive outcomes, a significant finding was that a higher number of adolescents who had previously undergone hypospadias surgery during childhood were classified as cases or borderline cases with respect to mental health issues. Hypospadias surgery in childhood may pose challenges for some patients during adolescence, particularly in the proximal group. Regular monitoring by healthcare professionals is crucial in providing necessary support. A limitation is the small size of the subgroups. ConclusionMost patients report good mental health, quality of life, and self-esteem even though patients with hypospadias report more mental health issues than the comparison group. Proximal hypospadias were less satisfied with penile appearance and sexual function. However, due to the small sample size, conclusions about this group should be treated cautiously. Assessing self-reported outcomes in follow-ups is important to identify adolescents who had hypospadias surgery and are at risk for reduced mental health.

Effect of the Green Cross method on patient safety culture in a postanaesthesia care unit: a longitudinal quasi-experimental study

BackgroundHospitals should adopt multiple methods to monitor incidents for a comprehensive review of the types of incidents that occur. Contrary to traditional incident reporting systems, the Green Cross (GC) method...

Long-Term Outcomes of Arthroscopically Verified Focal Cartilage Lesions in the Knee: A 19-Year Multicenter Follow-up with Patient-Reported Outcomes.

Focal cartilage lesions (FCLs) are frequently found during knee arthroscopies and may impair quality of life (QoL) significantly. Several treatment options with good short-term results are available, but the natural history without any treatment is largely unknown. The aim of this study was to evaluate patient-reported outcome measures (PROMs), the need for subsequent cartilage surgery, and the risk of treatment failure 20 years after diagnosis of an FCL in the knee. Patients undergoing any knee arthroscopy for an FCL between 1999 and 2012 in 6 major Norwegian hospitals were identified. Inclusion criteria were an arthroscopically classified FCL in the knee, patient age of ≥18 years at surgery, and any preoperative PROM. Exclusion criteria were lesions representing knee osteoarthritis or "kissing lesions" at surgery. Demographic data, later knee surgery, and PROMs were collected by questionnaire. Regression models were used to adjust for and evaluate the factors impacting the long-term PROMs and risk factors for treatment failure (defined as knee arthroplasty, osteotomy, or a Knee injury and Osteoarthritis Outcome Score-Quality of Life [KOOS QoL] subscore of <50). Of the 553 eligible patients, 322 evaluated patients (328 knees) were included and analyzed. The mean follow-up was 19.1 years, and the mean age at index FCL surgery was 36.8 years (95% confidence interval [CI], 35.6 to 38.0 years). The patients without knee arthroplasty or osteotomy had significantly better mean PROMs (pain, Lysholm, and KOOS) at the time of final follow-up than preoperatively. At the time of follow-up, 17.7% of the knees had undergone subsequent cartilage surgery. Nearly 50% of the patients had treatment failure, and the main risk factors were a body mass index of ≥25 kg/m2 (odds ratio [OR] for overweight patients, 2.0 [95% CI, 1.1 to 3.6]), >1 FCL (OR, 1.9 [CI, 1.1 to 3.3]), a full-thickness lesion (OR, 2.5 [95% CI, 1.3 to 5.0]), and a lower level of education (OR, 1.8 [95% Cl, 1.1 to 2.8]). Autologous chondrocyte implantation (ACI) was associated with significantly higher KOOS QoL, by 17.5 (95% CI, 3.2 to 31.7) points, and a lower risk of treatment failure compared with no cartilage treatment, microfracture, or mosaicplasty. After a mean follow-up of 19 years, patients with an FCL who did not require a subsequent knee arthroplasty had significantly higher PROM scores than preoperatively. Nonsurgical treatment of FCLs had results equal to those of the surgical FCL treatments except for ACI, which was associated with a better KOOS and lower risk of treatment failure. Full-thickness lesions, >1 FCL, a lower level of education, and a greater BMI were the main risk factors associated with poorer results. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Tactical capacity planning under uncertainty - a capacity limitation analysis.

Tactical capacity planning is crucial when hospitals must cope with substantial changes in patient requirements, as recently experienced during the Covid-19 pandemic. However, there is only little understanding of the nature of capacity limitations in a hospital, which is essential for effective tactical capacity planning. We report a detailed analysis of capacity limitations at a Norwegian tertiary public hospital and conducted 22 in-depth interviews. The informants participated in capacity planning and decision-making during the Covid-19 pandemic. Data are clustered into categories of capacity limitations and a correspondence analysis provides additional insights. Personnel and information were the most mentioned types of capacity limitations, and middle management and organizational functions providing specialized treatment felt most exposed to capacity limitations. Further analysis reveals that capacity limitations are dynamic and vary across hierarchical levels and organizational functions. Future research on tactical capacity planning should take interdisciplinary patient pathways better into account as capacity limitations are dynamic and systematically different for organizational functions and hierarchical levels. We argue that our study possesses common characteristics of tertiary public hospitals, including professional silos and fragmentation of responsibilities along patient pathways. Therefore, we recommend operations managers in hospitals to focus more on intra-organizational information flows to increase the agility of their organization. Our detailed capacity limitation analysis at a tertiary public hospital in Norway during the Covid-19 pandemic provides novel insights into the nature of capacity limitations, which may enhance tactical capacity planning.

Competing institutional logics in healthcare organizations: theorising digitalism

PurposeThe digitalisation of healthcare services has proven to be difficult, with numerous negative effects. We argue that the reason for the problem is not poor project management, but a clash of different institutional logics. The aim of this article is to explore, define and theorise the concept of digitalism, as a term for a new institutional logic in contrast to other, more known logics in organisations, such as managerialism and professionalism, to better understand processes of digitalisation.Design/methodology/approachWe illustrate our arguments with a case study of a process of organizational development before and after the implementation of centralised large-scale IT systems at a large Norwegian hospital. Data was extracted from documents and observations from January 2015 to January 2016 during an organizational audit. In addition, a follow-up study was conducted in 2019 and 2024 by interviewing eight key personnel who were involved in the implementation process.FindingsThe implementation of a new digital health record in a Norwegian hospital is a process of social restructuring that involves new actors, logics and control systems. The process of digitalisation shows us how digitalism create tensions, diverges and merges with other institutional logics.Practical implicationsUnderstanding digitalism as a sensitising concept offers insights into how large-scale technology and organizations are tied together and can help to reduce organizational dysfunctionalities and improve the implementation of IT systems.Originality/valueThis study contributes to a new understanding of digitalisation processes and links an ongoing theoretical debate on the digitalisation of organizations with empirical findings.

Nurses’ views on supporting young adults with terminally ill parents in Norwegian hospitals

Nurses’ views on supporting young adults with terminally ill parents in Norwegian hospitals

Child Maltreatment: To Report or Not to Report? It’s More Complex than That

Child maltreatment (CM) is a widespread problem, contributing to health and societal difficulties often throughout the lifespan. Healthcare professionals (HCPs) who see potential warning signs for CM are responsible for protecting the child from future harm, which may involve alerting the authorities. The decision-making is challenging as unwarranted reporting may lead to mistrust and not benefit the child. We sought to explore what factors might influence HCPs’ decisions to report suspected CM in a Norwegian sample. Using a cross-sectional survey among HCPs in Norwegian hospitals with pediatric wards, we presented five case vignettes describing different probabilities of CM and variables assessing experience, knowledge, and confidence. A total of 382 HCPs completed the survey. Despite recognizing warning signs for CM in the case vignettes, a large proportion were reluctant to report to authorities. Recognition of CM and expressed willingness to report four or all five of the case vignettes (high reporters) was associated with the profession, knowledge, experience, and confidence in handling CM cases. Expressed confidence in performing physical examinations for physical or sexual abuse and talking with parents about abuse was significantly associated with high reporting (OR 2.3 to 17.8). Qualitative data further supported the role of self-efficacy. In summary, reporting to the authorities is an important but complex aspect in cases of suspected CM, but many HCPs relate that they fail to do so. This study indicates reporting suspicion of CM is correlated with self-efficacy and knowledge among HCPs, which should inform educational, social, and policy decisions.

Exploring the Enterprise BIM concept in practice: The case of Asset Management in a Norwegian hospital

Exploring the Enterprise BIM concept in practice: The case of Asset Management in a Norwegian hospital

Reducing sickness absence: a work environment intervention in Norwegian hospitals

BackgroundHigh rates of sickness absence is a challenge within the healthcare sector, highlighting the need for effective interventions. Despite this, limited research has been conducted on the impact of such interventions within the healthcare context. This study evaluates an intervention aimed at improving the work environment influences sickness absence rates in Norwegian hospital units. The intervention is a comprehensive framework for discovering and tailoring solutions to each units’ specific needs, with a focus on employee involvement and collaboration between leader, union representatives and safety delegates.MethodsWe employed two methodological approaches. Method 1 involved using HR-registered sickness absence data to track changes in sickness absence across all intervention units and matched control groups over a three-year period. In Method 2, we used a pre- and post-survey design in 14 intervention units, focusing on employees’ job satisfaction and self-reported health.ResultsThe results of the intervention were mixed. There was a significant decrease in total sickness absence in the intervention units the first year after the intervention, and a significant decrease in long-term sickness absence both in the first and second year after the intervention, measured with HR registries. However, we did not see a significant larger decrease in total sickness absence in the intervention units compared to the control units and only partial support for a larger decrease in long-term absence in the intervention units. In the subsample of units that also participated in the survey, we observed significant improvements in employee job satisfaction post intervention.ConclusionsThere is a need for research on effective interventions to reduce sickness absence in the healthcare sector. “Where the shoe pinches” provides a potential methodological framework for reducing sickness absence by addressing challenges in the work environment, however with uncertain results. Further exploration is warranted to refine strategies for effectively managing sickness absence within healthcare organizations.

Workplace health promotion in a continuous Rationalised Hospital sector

The article explores the complexities of implementing health-promoting physical activity within the context of a Norwegian public hospital. Through an extensive case study, it examines the rollout of Active Hospitals, a program crafted in alignment with prevailing best practices in workplace physical activity. Departing from prior studies, the article adopts the perspective of the implementation facilitators. It illustrates how the implementation process faced obstacles stemming from new organizational paradigms, characterized by heightened rationalization, standardization, and perpetual restructuring within the sector. Consequently, the article underscores how reforms associated with New Public Management significantly limits health policies' ambitions to turn the workplace into a health-promoting setting These challenges are particularly pertinent concerning the enduring goals of social sustainability.

Economies of scope in the Norwegian public hospital sector.

This study investigates the potential economies of scope in the Norwegian public hospital sector after a major structural and organizational reform. Economies of scope refers to potential cost savings occurring from the scope of production rather than the scale. We use a data driven approach to distinguish between relatively specialized and differentiated hospitals. Using registry data spanning the period 2013-2019, we use non-parametric data envelopment analysis with bootstrapping procedures to investigate the potential presence of economies of scope. This is done separately for three different dimensions of which hospital production can be either specialized or differentiated. The findings suggest that economies of scope are present in the Norwegian hospital sector, meaning that there are cost savings related to the optimal differentiation of the activity. It is difficult to conclude on how these findings relate to the reform.

A retrospective study of non-ventilator hospital-acquired pneumonia in a Norwegian hospital: a serious medical condition in need of better and timelier microbiological diagnostics

Background Hospital-acquired pneumonia (HAP) is the most common hospital-acquired infection (HAI). HAP is associated with a high burden of morbidity and mortality, but the diagnosis is difficult to establish and the incidence uncertain. Methods Patients aged ≥ 18 years hospitalised with radiologically verified non-ventilator hospital acquired pneumonia (NV-HAP) during 2018 were retrospectively identified at Drammen Hospital, a Norwegian general hospital. Infectious Diseases Society of America and the American Thoracic Society’s definition of HAP was used. Results In total 119 cases of NV-HAP were identified among 27,701 admissions. The incidence was 4.3 per 1000 admissions and 1.2 per 1000 patient-days. The median age was 74 years, 63% were male and median Charlson comorbidity index was 5. Coronary heart disease (42%) was the most common comorbidity. Median length of stay was 17.2 days. A blood culture was obtained in 53.8% of patients, while samples from lower airways were seldom obtained (10.9%). In-hospital mortality was 21%, accumulated 30-day mortality was 27.7% and accumulated 1-year mortality was 39.5%. Thirty-day readmission rate among survivors was 39.4%. Conclusion NV-HAP was present in approximately 1 in 250 hospitalisations, most had multiple comorbidities, and 1 in 5 died in hospital. Although thorough microbiological sampling is recommended when NV-HAP is suspected, our data indicate that airway sampling is infrequent in clinical practice. Our findings underscore the need to develop microbiological diagnostic strategies to achieve targeted antimicrobial treatment that may improve patient outcomes and reduce broad-spectrum antibiotic usage.

DNA ploidy and PTEN as biomarkers for predicting aggressive disease in prostate cancer patients under active surveillance

BackgroundCurrent risk stratification tools for prostate cancer patients under active surveillance (AS) may inadequately identify those needing treatment. We investigated DNA ploidy and PTEN as potential biomarkers to predict aggressive disease in AS patients.MethodsWe assessed DNA ploidy by image cytometry and PTEN protein expression by immunohistochemistry in 3197 tumour-containing tissue blocks from 558 patients followed in AS at a Norwegian local hospital. The primary endpoint was treatment, with treatment failure (biochemical recurrence or initiation of salvage therapy) as the secondary endpoint.ResultsThe combined DNA ploidy and PTEN (DPP) status at diagnosis was associated with treatment-free survival in univariable- and multivariable analysis, with a HR for DPP-aberrant vs. DPP-normal tumours of 2.12 (p < 0.0001) and 1.94 (p < 0.0001), respectively. Integration of DNA ploidy and PTEN status with the Cancer of the Prostate Risk Assessment (CAPRA) score improved risk stratification (c-index difference = 0.025; p = 0.0033). Among the treated patients, those with DPP-aberrant tumours exhibited a significantly higher likelihood of treatment failure (HR 2.01; p = 0.027).ConclusionsDNA ploidy and PTEN could serve as additional biomarkers to identify AS patients at increased risk of developing aggressive disease, enabling earlier intervention for nearly 50% of the patients that will eventually receive treatment with current protocol.

Ambulance professionals' experiences of teamwork in the context of a team training programme – a qualitative study

BackgroundTeamwork in the context of ambulance services exhibits unique characteristics, as this environment involves a small core team that must adapt to a dynamic team structure that involves health care professionals and emergency services. It is essential to acquire a deeper understanding of how ambulance teams operate. Therefore, this study aimed to explore the experiences of ambulance professionals with teamwork and how they were influenced by the implementation of a team training programme.MethodsA qualitative descriptive study was conducted involving ambulance professionals who took part in focus group interviews carried out both before and after the implementation of a team training program across seven ambulance stations within a Norwegian hospital trust. The data were analysed using reflexive thematic analysis based on a deductive-inductive approach.ResultsOur analysis revealed 15 subthemes that characterised ambulance professionals’ experiences with teamwork and a team training programme, which were organised according to the five main themes of team structure, communication, leadership, situation monitoring, and mutual support. Ambulance professionals’ experiences ranged from the significance of team composition and interpersonal and professional relationships to their preferences regarding different communication styles and the necessity of team leaders within the ambulance service. The team training programme raised awareness of teamwork, while the adoption of teamwork tools was influenced by both individual and contextual factors. The Introduction/Identity, Situation, Background, Assessment and Recommendation (ISBAR) communication tool was identified as the most beneficial aspect of the programme due to its ease of use, which led to improvements in the structure and quality of consultations and information handover.ConclusionsThis study documented the diverse characteristics and preferences associated with teamwork among ambulance professionals, emphasising the particular importance of proficient partnerships in this context. Participation in a team training programme was perceived as a valuable reminder of the significance of teamwork, thus providing a foundation for the enhancement of communication skills.Trial registrationClinicalTrials.gov—ID: NCT05244928.

Learning from patient safety incidents: The Green Cross method.

Hospitals can improve how they learn from patient safety incidents. The Green Cross method, a proactive reporting and learning method, is one strategy to meet this challenge. In it, nurses play a key role. However, describing its impact on learning from the users' perspective is important. This study aimed to describe nurses' experiences of learning from patient safety incidents before and 3 months after implementing the Green Cross method in a postanaesthesia care unit. A qualitative study with an inductive descriptive design with focus group interviews was conducted before and 3 months after implementing the Green Cross method to assess its impact. The data were analysed using qualitative content analysis. The study was conducted in a postanaesthesia care unit in a Norwegian hospital trust. Before implementing the Green Cross method, participants indicated limited openness and learning, including the subcategories 'Lack of openness hampers learning', 'Adverse events were taken seriously' and 'Insufficient visible improvements'. After implementing the Green Cross method, participants indicated the emergence of a learning environment, including the subcategories 'Transparency increases learning', 'Increased patient safety awareness' and 'Committed to quality improvements'. Implementing the Green Cross method in a postanaesthesia care unit positively impacted openness and nurses' patient safety awareness, which is crucial for learning and improving quality. The Green Cross method could be useful for organizational learning and facilitating learning from patient safety incidents through transparency, discussion and involvement of nursing staff.

Primary care doctors in acute call-outs to severe trauma incidents in Norway – variations by rural-urban settings and time factors

BackgroundA severely injured patient needs fast transportation to a hospital that can provide definitive care. In Norway, approximately 20% of the population live in rural areas. Primary care doctors (PCDs) play an important role in prehospital trauma care. The aim of this study was to investigate how variations in PCD call-outs to severe trauma incidents in Norway were associated with rural-urban settings and time factors.MethodsIn this study on severe trauma patients admitted to Norwegian hospitals from 2012 to 2018, we linked data from four official Norwegian registries. Through this, we investigated the call-out responses of PCDs to severe trauma incidents. In multivariable log-binomial regression models, we investigated whether factors related to rural-urban settings and time factors were associated with PCD call-outs.ResultsThere was a significantly higher probability of PCD call-outs to severe trauma incidents in the municipalities in the four most rural centrality categories compared to the most urban category. The largest difference in adjusted relative risk (95% confidence interval (CI)) was 2.08 (1.27–3.41) for centrality category four. PCDs had a significantly higher proportion of call-outs in the Western (RR = 1.46 (1.23–1.73)) and Central Norway (RR = 1.30 (1.08–1.58)) Regional Health Authority areas compared to in the South-Eastern area. We observed a large variation (0.47 to 4.71) in call-out rates to severe trauma incidents per 100,000 inhabitants per year across the 16 Emergency Medical Communication Centre areas in Norway.ConclusionsCentrality affects the proportion of PCD call-outs to severe trauma incidents, and call-out rates were higher in rural than in urban areas. We found no significant difference in call-out rates according to time factors. Possible consequences of these findings should be further investigated.

Patient influx to emergency departments at two Norwegian university hospitals from 2012-21.

The increase in patient visits to emergency departments is a global challenge. We wished to survey patient inflow and patient composition over time at two Norwegian university hospitals. A retrospective, descriptive study of patient contacts (patients ≥16 years of age) in the emergency departments of Haukeland University Hospital, Bergen, and St Olav's Hospital, Trondheim University Hospital in the period 2012-21. Data were retrieved from patient records and the patient administration system. A total of 585780 patient contacts were included. The number of patient contacts in the emergency departments was 30696 in 2012 and 40396 in 2021 at Haukeland University Hospital, and 18967 in 2012 and 28822 in 2021 at St Olav's Hospital. The largest increase during the study period appeared to be in the age group 67-79 years, with an increase of 57% (from 6190 to 9691) at Haukeland University Hospital, and 77% (from 3849 to 6817) at St Olav's Hospital. The proportion of patient contacts that ended in hospitalisation was 82% in 2012 and 74% in 2021 at Haukeland University Hospital, and 87% in 2012 and 61% in 2021 at St Olav's Hospital. Of the patients that were admitted, the median age was 65 years, while the median age of those who were discharged from the emergency department was 48 years at Haukeland University Hospital and 52 years at St Olav's Hospital. The study showed an increase in patient contacts in the emergency departments at Haukeland University Hospital and St Olav's Hospital over a period of ten years. The number of older adults in the population will continue to increase in the years ahead, and the need for urgent care assessments will correspondingly increase. It is important that the health services are aware of changes in patient influx and patient composition in order to ensure patient safety and the working environment of emergency departments in the future.