Knee, hip replacement wait times reduced

Region’s hospitals have streamlined referral services

The Ottawa region is steadily reducing surgery wait times for patients undergoing hip and knee replacements, local health officials said Wednesday.

Consolidation of referral services and a collapsing of other “silos” in the summer have forced hospitals to work together and avoid the continued embarrassment of having the longest wait lists for hip surgery in the province and 10th-longest among 14 provincial health regions for knee replacements.

“We’ve moved from essentially last place to the middle of the pack,” said Queensway-Carleton Hospital president and chief executive officer Tom Schonberg, who led a working group of hospital CEOs and “medical leaders” charged with fixing the wait-time problem. “We only instituted this fully in September and we’ve already seen improvements. It’s a work in progress.”

According to the Champlain Local Health Integration Network (LHIN), as of the end of October, 72 per cent of people in line for non-emergency hip and 79 per cent of knee-surgery patients are now waiting 182 days.

The goal is to have the average wait times down to between 112-168 days within a year.

Last year, the longest wait for joint replacements was at The Ottawa Hospital (421 days) and Cornwall Community Hospital (303), with Queensway-Carleton performing the best at 186.

The provincial goal for both surgeries is 182 days, but QueenswayCarleton is already below that.

The hospitals blamed much of the overall poor performance on increasing demand from an aging population, with the QueenswayCarleton reporting last year that it had seen a three-fold increase in demand — from 450 joint replacements in 2008 to 1,200 and steadily increasing.

But a streamlining of referral services, and the closing of the referral clinic at The Ottawa Hospital, means that physicians fax referrals to a central location, which passes them to a referral site closest to patients’ homes.

Patients are assessed by a physiotherapist or nurse for about 45 minutes and only those with knee and hip problems requiring surgery — on average about 60 per cent — will see a surgeon. Previously, surgeons did the assessments.

“So you’re not wasting that time,” Schonberg said after presenting his interim findings to a LHIN board of directors meeting. “If I have to wait months and months to get to the surgeon that could all be wasted time. This way, a lot more spots are available so you don’t have that other 40 per cent clogging up your office time and they can automatically see the 60 per cent quicker. You’ve increased the capacity without really increasing office time.”

Another part of the backlog was caused by some surgeons with wait lists of up to 18 months. They are no longer taking new patients but concentrating instead on getting the backlog cleared to a maximum sixmonth wait — a move Schonberg says was voluntary.

Many patients have favoured hospitals or preferred surgeons and that has also been a factor in causing delays.

Those on the waiting list are now being given the clear choice of the first available surgeon and getting the surgery done more quickly or choosing their preferred doctor and potentially waiting a lot longer.

LHIN CEO Chantale LeClerc said in an interview that hospitals had been working in “silos” and dragging down the region’s collective wait-time performance.

“We told them we need you to be working together so we can bring the whole region’s performance up,” she said. “It’s not OK for one hospital to be doing well and another not. So what you’re seeing now is a collective approach.”