How can we reduce wait times for much needed hip and knee replacement surgery in Canada? Coordinated referral and team-based care models show promise, according to research published in CMAJ (Canadian Medical Association Journal).
In Canada, there are long wait times for scheduled surgeries, such as hip and knee joint replacements, which can lead to worsening pain and mobility problems and affect overall health. Canada falls well behind in international comparisons of health systems based on wait times. To address this issue, some Canadian provinces have been experimenting with private for-profit delivery of some surgeries, but there are other potential solutions.
“…Other policy approaches, such as single-entry referral models and team-based care, could reduce surgical wait times substantially and improve geographic and socioeconomic inequities in wait times, which might worsen with other types of interventions,” writes Dr. David Urbach, head of the Department of Surgery and director of Perioperative Services at Women’s College Hospital and professor at the University of Toronto, Toronto, Ontario, with coauthors. “If the potential benefit of these models of care were better quantified, policy-makers and health authorities could more persuasively champion their implementation, which faces stiff resistance from some participants in the health system.”
Researchers compared 3 models of care in the study to determine if there is a better option to deliver surgery more quickly. The research included all patients referred to an orthopedic surgeon by a general practitioner or family physician in 2017 who underwent non-urgent hip or knee joint replacements and for whom there were complete wait time data. The model simulations were based on data from 17 465 surgeries on 17 132 patients, 7783 referring physicians, 274 surgeons, and 71 hospitals from 5 regions in Ontario.
The 3 models of care included single-entry referral or “central intake,” where all patients in each of 5 regions are pooled and queue for the next specialist for consultation; team-based care, where patients enter a regional pool after consultation and queue for surgery in their region; and a fully integrated model, where patients are pooled in a queue to be seen by the next available surgeon in their region then enter another queue for surgery from the next available surgeon in their region.
Both team-based and fully integrated models had much larger effects on reducing wait times than the single-entry referral model.
“Our results provide strong support for the implementation of both single-entry referral models and team-based care as a regional solution to the problem of long wait times for scheduled surgery in Canadian health systems, as well as an effective strategy to improve equity in access to health services. Adoption of these models will require strong leadership among health system leaders and the active participation of surgeons. It will also require some investment in system infrastructure, instead of one-time investments to increase surgical volumes during times of crisis,” write the authors.
“Effect of single-entry referral models and team-based care on wait times for hip and knee joint replacement in Ontario: a simulation study” is published May 20, 2025.