93. REDUCING TOTAL HIP AND KNEE SURGICAL WAIT TIMES: A MODEL THAT WORKS

Abstract

Purpose: Reducing wait times for total hip (THA) or knee (TKA) joint arthroplasty is a Canadian health care priority. Models that maximise the capacity of advanced practice clinicians (nurses, physical therapists, sports medicine specialists) have been established to streamline care. Hospitals across the Hamilton Niagara Haldimand Brant Local Health Integration Network in Ontario collaborated to establish a Regional Joint Assessment Centre (RJAC). This study was designed to profile patients deemed suitable for surgical review, and to examine wait times for THA or TKA in RJAC patients compared to those referred directly to an orthopaedic surgeon’s office.

Method: Patients referred to the RJAC between July 2007 and August 2008 with knee or hip OA were included. Self-reported function was evaluated using the Oxford Hip and Knee Score that is scored out of 60 (higher scores reflect greater disability). Time to surgery was measured as the number of days from initial review to surgery. Group one consisted of patients that were referred to the RJAC while group two was comprised of patients who were referred directly to a surgeon’s office. Patient characteristics were examined using univariate analyses. Independent t-tests were used to examine between group differences.

Results: One hundred thirty-six patients (mean±sd: 68±2 years, body mass index 31±6 kg/m2, 83 females) with 150 hip and/or knee joint problems were reviewed in the RJAC. Of those, only 33% (45/136 patients) were deemed suitable for surgical review. Self-reported function (Oxford Scores) in the group requiring surgical review was significantly worse (40±7, p=0.03) than in those patients deemed unsuitable for surgical review (37±9). The RJAC group waited on average 130 days for THA and 129 days for TKA (below the provincial target of 182 days) while those referred directly to the surgeons’ offices waited significantly longer (194 days for THA and 206 days for TKA, p< 0.001).

Conclusion: Patients with hip and knee OA who require surgical review have worse self-reported function than those triaged to conservative care. Wait times for THA or TKA were significantly shorter for patients referred to the RJAC under the new model of care than for those referred directly to an orthopaedic surgeon’s office.