Alberta has dramatically cut wait times for hip and knee
replacements thanks to their innovative Hip and Knee Replacement
Project. The pilot project, now into its 11th month, reduced
waits for joint replacements from 47 weeks to four.
"The interim results from the first
six months were very promising," says Michele Lahey,
the executive VP and CEO of health service at Capital
Health, which serves the Edmonton area. She adds that
not only have wait times been cut, but so has the duration
of time patients are spending in hospital — "from
seven to four days."
Those on the front lines are just
as upbeat. "The physicians are very happy," says Dr
Don Dick, the president of the Alberta Orthopedic Society
— one of the project's proponents. "Just having
some certainty that the patient knows they're going
to get seen really helps."
Dr Ron Zernicke, executive director
of Alberta Bone and Joint Health Institute agrees. "The
physicians and hospital staff involved notice the difference
in patient outcomes. Patients are getting in to see
surgeons faster and the rehab stay is shorter."
HOW
IT WORKS
The key to the pilot project is the multidisciplinary
assessment clinic, which essentially cuts out the referral
process and reduces the number of unnecessary procedures.
"It's a much more centralized approach," says Ms Lahey.
"All patients are accessed in the clinic using standardized
criteria to see if they're appropriate for surgical
intervention."
In some cases patients might not
be ready for surgery, explains Ms Lahey. They may need
to lose weight, get their diabetes in check or quit
smoking. These patients are monitored until the time
they're ready for surgery.
FPs
ARE KEY
To streamline the referral process, doctors had to rethink
the way they'd been working. "Right now FPs will send
out a referral request to multiple surgeons," explains
Dr Dick. "But [with the new system] they just have to
send one to a central place." He believes this gives
family physicians more certainty that their patients
will be seen. "Most family doctors are very happy with
it."
And family doctors play a central
role in the project. "FPs are very important," emphasizes
Dr Zernicke. "They're the ones developing the set of
evaluative materials that are transferred to the central
clinic. They are very much a part of the process."
FREEDOM
OF CHOICE?
The project hasn't gone without some criticism. Dr Allan
Drummond, a family doctor in Perth, ON, has been following
the Alberta pilot project closely. In December he wrote
a letter to the Globe and Mail voicing his concerns.
He concedes the program "is very innovative," but he's
worried that it removes an important step in the care
process: the element of choice. "Physicians and patients
should be able to choose a surgeon," he says. "A lot
of patient outcomes revolve around choice. If this kind
of strategy was endorsed, it would remove that choice."
Such fears are unfounded, says
Dr Zernicke. "People actually still have choice," he
insists. "But if they want the first available physician,
they might not get the one they want."
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