The right care at the right time: The Total Joint Assessment Centre

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Reducing surgical wait times and improving patient care are the founding principles behind the Total Joint Assessment Centre (TJAC) which recently opened its new satellite location at Markham Stouffville Hospital Corporation’s Markham site.

The new satellite clinic was implemented in order to further improve upon the centralized model of care by bringing all the benefits of the centre closer to home for hip and knee replacement patients.

“TJAC is an initiative to help reduce wait times for hip and knee surgeries and free up the surgeons for those surgeries,” says Julia Scott, Vice President of Clinical Programs at Markham Stouffville Hospital. “By providing the option of a central or satellite location where people can come and be assessed, we have streamlined the process for both surgeons and patients and improved patient care.”

The Total Joint Assessment Centre is a tri-hospital partnership that began two years ago between three GTA hospitals – North York General Hospital, Markham Stouffville Hospital and York Central Hospital. The central site of the TJAC is located at North York General Hospital’s Branson Site and clinicians from the central site staff the satellite clinic at Markham Stouffville Hospital.

“Prior to TJAC, patients would normally be referred by their doctor or specialist directly to a surgeon for assessment and treatment,” explains Scott. “This resulted in a huge backlog of work for the surgeon and a long wait time for the patient. Now with TJAC, patients are quickly assessed and provided with treatment options much more quickly.”

Patients are still referred to TJAC by their doctor or specialist. However, once at the clinic, the patient is assessed by a clinician who can determine what sort of treatment is best for the individual.

“Using clinicians who have the ability to conduct advanced orthopedic assessments has proven to be efficient and effective in streamlining care for potential joint replacement candidates,” says Cathy Pierce, Clinical Manager of Rehabilitation Services and Orthopedic Clinics at Markham Stouffville Hospital. “Clinicians are able to determine if a patient is or is not a candidate for a surgical procedure and through this care model they have been able to screen out approximately 30 per cent of patients who are not emotionally ready for a surgery or would prefer to look at other treatment options.”

“We provide a comprehensive assessment of a patient’s condition and whether or not they need surgery,” says Anna Gutlin, a physiotherapist and clinician with TJAC. “Aside from determining whether a patient is a good candidate for joint replacement surgery, we can also provide them with links to other conservative management options if they choose not to have surgery. Furthermore, we provide patients with pre-op teaching, obtain their past medical history, educate them on their condition and discuss their x-ray findings. A complete assessment can take anywhere from 45 minutes to an hour.”

“That is time that many surgeons can’t provide their patients,” adds Scott. “With so many patients looking for treatment, it’s not the best use of a surgeon’s time to spend an hour or more educating patients on surgical options. That’s why they are so supportive of TJAC; because the clinicians do the preliminary work and prepare the patients for surgery or other treatment. This allows surgeons to focus on surgeries and helping patients. TJAC is really a testament to the overall interdisciplinary approach we have to providing our patients with the right care at the right time in the right place.”

Clinicians are also able to answer questions and counsel patients who may be concerned about undergoing a surgical procedure. “We find that a good portion of our patients are less anxious about undergoing surgery because of the support and information that we give them,” says Gutlin. “From a patient and surgeon perspective, that’s overwhelmingly positive because patients are better informed and prepared for their surgery and surgeons only have to do a brief overview and not spend as much time counseling patients about the surgery.”

“For patients who are not ready to pursue surgical intervention, we send a consult note back to the referring doctor with suggestions of conservative treatment options,” says Sandra Hehn, a Registered Nurse and TJAC Clinician. “If within six months of their initial referral a patient decides they want to pursue surgery, they can directly call the clinician who assessed them to facilitate a surgical consultation or reassessment as needed. That prevents them from having to go through the process all over again.”

The Markham Stouffville Hospital site of the Total Joint Assessment Centre opened on March 16. The new satellite location provides assessment and treatment options to patients quickly, effectively and close to home. The addition of the satellite is also expected to help further reduce wait times and increase the overall volume of services being provided by the centre.

“Through TJAC we have reduced the referral to assessment time from months to weeks, while at the same time offering patients more choice, better linkages and greater knowledge of their condition and potential surgical procedure,” says Pierce.

Though the Markham site hasn’t been open long enough to accurately measure its impact on wait times, officials say they expect to see a significant reduction in the length of time it takes for a TJAC patient to receive surgery once they are assessed by clinicians. The Ontario Ministry of Health and Long-Term care has a recommended time frame of approximately 182 days.

For more information on TJAC, visit www.tjac.ca.