Hotel Dieu Hospital fast-tracks hip and knee replacements

A fast-track surgery program at Hotel Dieu Hospital in Kingston is living up to its name as it downsizes wait lists for hip and knee replacements, speeds patients through their hospital stays and clears the way for more total joint replacement (TJR) surgeries in the South East region.

The first of its kind in the region served by the South East Local Health Integration Network (SE LHIN), the innovative program—funded for 160 TJR cases annually—has completed more than 300 successful surgeries since its inception two years ago.

“This is a new way of business and new model for efficient care,” says Dr. Peter Brown, medical director for the joint Hotel Dieu/ Kingston General Hospital (KGH) surgery program. “It’s about thinking outside the box and producing true innovation in health care.”

Previously, all hip and knee replacement surgery occurred at KGH. The TJR program broke new ground by targeting “well” patients who can easily manage a 48-hour hospital stay and who also have access to post-operative supports at home.

Patients spend the 48-hour post-surgery recovery period in the hospital’s extended care unit where they receive physiotherapy three times daily and occupational therapy as needed. When they leave the hospital, patients continue with outpatient physiotherapy at Providence Care, the region’s leading rehabilitation hospital.

“Premium planning is at the heart of this program’s success,” says Rosemary Koen, nurse coordinator for the TJR program. “Medical, nursing and allied health staff all work hard to prepare patients ahead of hospitalization. Together, they create the optimum discharge plan that covers everything from adequate home support to equipment needs to post-discharge physiotherapy appointments.”

That level of teamwork, says patient (and community nurse) Linda Henson, translates into smooth sailing for patients.

“I had the surgery on Monday, was up on my feet the same night and was home on Wednesday,” she says. “The whole process was a model of teamwork. The surgeon, nurses, physiotherapist, occupational therapist knew their roles exactly—every ‘t’ was crossed and ‘i’ dotted. In one word, my experience was perfect.”

Even patients whose health status necessitates surgery at KGH are benefiting from the short-stay program now that some components of care—such as mobilizing patients sooner after surgery and using a different approach to pain control—have been transferred to KGH.

And the care providers themselves are highly satisfied.

A survey of the TJR program’s allied health team indicated that 94 per cent of respondents strongly agreed that patient outcomes based on quality indicators were a top priority for the program and 85 per cent indicated they felt well supported by their interdisciplinary colleagues.

“The team responded in an overwhelmingly positive fashion,” says Rosemary. “They felt strongly that they were providing quality care in a highly collaborative environment.”

“This model of care delivery has the potential to improve access to surgical care for patients needing hip and knee replacements, improve wait times and maximize our efficiency as an outpatient care centre,” says Hotel Dieu’s CEO Dr. David Pichora. “Also exciting is the fact that the model is transferable to other types of surgery. That could revolutionize the delivery of surgical care in this region.”