A joint effort for timely care

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Innovation, partnership, and patient-focused care are the cornerstones of the Total Joint Assessment Centre’s (TJAC) success in reducing wait-times for knee and hip replacement surgery.

Located at North York General Hospital’s Branson site, the TJAC is a joint effort between Markham Stouffville, North York General and York Central hospitals which has improved patient care by significantly reducing wait times for assessment, and hip and knee replacement surgery.

The results of this innovative model of care speak for themselves. From January to July 2007, the average wait for TJAC patients – from the decision to treat to the surgical date – was seven weeks compared to 17 weeks for patients who did not go through TJAC.

Dr. Mac Con, Orthopedic Surgeon at York Central Hospital says: “The Total Joint Assessment Centre puts surgeons where they are needed – in the operating room.

Reducing wait-times has taken creativity and collaboration – requiring freeing up surgeons’ time in the office so they can spend more time operating,” he explains. “The TJAC model of care is one of the first in Ontario, benefiting our communities by reducing wait-times and improving the patient’s surgical experience.”

Improving the experience means spending quality time with each patient in a one stop centre. On their first visit, patients referred by their family physician receive a complete assessment from an interdisciplinary team. The team includes a physiotherapist, registered nurse and an acute care nurse practitioner – all specializing in musculoskeletal health.

If the assessment determines high probability of hip or knee replacement a second appointment at the centre with an orthopedic surgeon is arranged within two to three weeks.

“Patients at the TJAC receive a comprehensive assessment and health teaching, they’re not rushed through the centre,” says Dr. Ted Rumble, Orthopedic Surgeon at North York General Hospital. “They leave confident it was a complete and thorough evaluation based on their condition and needs.”

Rumble says the plan includes identification of pre and post operative risk factors and developing goals with the patients. “The centre will soon incorporate case management into care delivery, so patients awaiting surgery will benefit even further,” he says. “This streamlined process at the TJAC decreases the stress that patients often experience with several appointments in different locations.”

Patients can choose to have their surgery at any of the three hospitals, with a surgeon of their choice, or with a surgeon who has the earliest appointment. The surgeon will offer candidates a surgery date within 26 weeks of their referral. This period is consistent with the Ontario government’s access targets.

For non-surgical patients a plan of care is provided. This can include recommendations about exercise, diet and other lifestyle advice on how to manage their condition more effectively. They are referred back to their family physician and/or to an alternative community resource.

“The demand for hip and knee replacement is increasing as people live longer, are more active or, conversely, as obesity rates rise and people get heavier, explains Rumble. He adds: “The demand is skyrocketing, because it’s so successful at helping patients regain their quality of life. Ontario is currently short about 100 orthopedic surgeons, but the needs of our communities are increasing as our population ages.”

According to the Arthritis Society, the majority of patients who need hip and knee replacement suffer from arthritis. Arthritis can severely impact a person’s quality of life and even their ability to work. Arthritis sufferers make almost double the number of visits to their doctors than those without it. Improving wait times with joint efforts will help ease the impact of arthritis on the health-care system.