New HIQA recommendations to shorten patient waiting times for high volume surgeries

Date of publication:

A series of health technology assessments (HTAs) published today by the Health Information and Quality Authority recommend the introduction of referral and treatment guidelines for certain scheduled surgical procedures.

The aim of these HTAs is to ensure a more efficient referral process, standardise the care provided and ultimately improve patient access to beneficial surgery.

Dr Máirín Ryan, Director of Health Technology Assessment in HIQA, said: “The HTAs being published today follow a public consultation by HIQA. Their aim is to provide evidence-based advice on potential referral or treatment thresholds for procedures where the benefit may be limited for some patients unless undertaken within strict clinical criteria.”

Four high-volume surgeries were included in this assessment: varicose vein surgery (vascular surgery); tonsillectomy; grommet insertion and adenoidectomy; and cataract surgery.

Dr Ryan said: “Referral thresholds are not new to the Irish system; they are currently being used by many primary care practitioners and surgeons, but not necessarily consistently.”

Dr Ryan said: “For the procedures assessed in these HTAs, which have high levels of demand, the introduction of thresholds may not necessarily have an impact on the overall number of surgeries performed annually. The thresholds will potentially provide patients and their doctors with greater clarity about the clinical criteria used by surgeons to inform the decision to operate. The thresholds, where possible, should minimise referral to surgical outpatients of patients who do not proceed to surgery.

“The use of transparent criteria may also allow for more equitable access to beneficial care throughout the publicly funded healthcare system.” Dr Ryan said.

Dr Ryan concluded: “Streamlining referrals to surgeons should help ensure that the right patients are referred for treatment at the right time, potentially releasing capacity and resources without causing harm to patients or reducing potential clinical benefit.”


Further Information: 

Sinead Whooley, Communications Manager, Health Information and Quality Authority, Tel: 01 814 7488/ 087 922 1941 Email:

Notes to the Editor: 

  • For full copies of the reports please go to You may also find us on Facebook and Twitter by searching ‘HIQA’.
  • HIQA is the statutory organisation in Ireland with a responsibility to carry out national health technology assessments (HTAs) and to develop guidelines for the conduct of HTAs across our healthcare system.
  • A scheduled surgical procedure is a pre-planned procedure where the patient can have their admission and surgery at a predetermined and predictable time.
  • Hospital In-Patient Enquiry (HIPE) scheme data indicates that varicose vein surgery, cataract surgery, tonsillectomy and grommet insertion are high volume surgical procedures undertaken in Irish public hospitals. These four procedures were assessed and evidence-based reports and recommended referral or treatment thresholds developed.
  • The most recent discharge data available from public hospitals, from 2011, indicates that there were approximately:
    • 3,500 discharges for patients who had undergone varicose vein surgery, the majority of whom (98%) did not have a documented discharge diagnosis of inflammation or ulceration.
    • 3,500 discharges for patients who had undergone tonsillectomies, the principal diagnosis being chronic tonsillitis for both children and adults.
    • 3,400 discharges for patients who had undergone grommet insertion surgery, the principal diagnosis being otitis media with effusion (OME) or ‘glue ear’ for both children and adults. Surgical management of OME may involve concomitant adenoidectomy and as such this procedure was also reviewed.
    • 9,500 discharges for patients who had undergone cataract surgery.
  • The HTA reports for this phase of the project were reviewed and approved by the Executive of the Authority. Originally requested by the Health Service Executive, the completed evaluation has been submitted to the HSE and to the Minister for Health for consideration.