- What was the Alberta Hip and Knee Replacement Pilot Project?
The Alberta Hip and Knee Replacement Project was designed to improve the way we deliver care, resulting in shorter waiting times and better health outcomes for patients.
The new model of care includes more involvement by primary care physicians and the establishment of central assessment clinics to reduce the number of inappropriately referred patients, particularly those that don't require surgery.
Primary care physicians will become more involved in preparing patients for surgery and caring for them following their procedure.
This should help to optimize patient for surgery as they near their surgical date and result in fewer patients not making it through to surgery the first time.
- How did the pilot work?
Through a shared plan, patients who don't require surgery were identified earlier to prevent unnecessary waits for care. Those who did require surgery received more support before and after their operation to ensure the best possible outcomes. In both cases, improving communication between family physicians and specialists improved the system's ability to plan for the patient's needs.
For those patients waiting for surgery, an individualized surgical plan was put in place for them. Example:
- If exercises to strengthen the patient were necessary, the physiotherapist put the patient on a pre-operative strengthening plan,
- If the patients needed weight and diet improvements, these supports were made available, and,
- If the patient needed to alter their home environment to adjust to post-surgical care, these changes were made in advance, instead of just before discharge from hospital.
This reduced unnecessary waits, delays and last-minute surgical cancellations. The patient was scheduled for surgery at a time that worked for their plan, the team and the system. All the appropriate care needs were booked in advance to avoid surprises and delays.
Each surgeon worked with a team to improve the efficiency and effectiveness of the operating room in order to complete four joint replacements per day. In many situations, the system performed only two cases per day per operating suite.
By organizing all the care requirements for the patients in advance (e.g. home care or physiotherapy that was required after surgery), and working with patients to ensure they were fit for surgery, we expected their length of stay in hospital and recovery time to be shorter.
- Who was involved in the project?
The project was administered by the Provincial Arthroplasty Working Committee, which included members from all the participating organizations:
The pilot involved:
- Three cities: Edmonton, Calgary and Red Deer
- 13 orthopaedic surgeons
- One assessment intake clinic in each city: Health First Strathcona for Edmonton; Health Resource Centre (HRC) for Calgary; and Central Alberta Hip and Knee Clinic in Red Deer
- One site of pracitce with staff who were dedicated to the project (if possible) in each city: Royal Alexandra Hospital in Edmonton; Health Resource Centre in Calgary; and Red Deer Regional Hospital in Red Deer.
- When did the project start and end?
The pilot project began accepting patients in each of the three participating cities; Edmonton, Red Deer and Calgary, in mid-March 2005.
Surgeries began in April 2005.
About 1200 new surgeries were completed in the province by the end of the pilot on March 31, 2006.
- How was it determined which patients will be able to access the pilot?
Patients' eligibility for hip or knee surgery through this pilot project were based on the criteria determined by the steering committee. This included only patients having primary hip or knee surgery. Patients who were selected needed to consent to participate in the project, ensure their availability for surgery during the timeframe and agree to the care plan determined by their health care team.
Individuals eligible for the project were contacted directly by their surgeron's office to determine their willingness to participate in the project.
All patients currently on the participating surgerons' wait lists, as well as new patients were considered for the pilot, but were selected based on a random process (i.e. luck of the draw).
- What is the role of the assessment clinics?
The assessment clinics will provide consistency for the patient in a complex care process that usually involves many health care providers and facilities. Today, a patient moves from one care provider and facility to another on his own. The new central assessment clinics will support the patient throughout the entire care pathway, bringing the team together for the patient and for their family.
The clinics employ a multidisciplinary team that works with the surgeons and other specialists to perform pre-operative evaluations and provide an optimizationplan for the patient. At the same time, a case manager will work with the patient and healthcare team to ensure the patient achieves specific clinical benchmarks across the entire care continuum. For example, the stnadard length of stay will be four days. In some cases, we may arrange for home care services to provide additional support for thepatient at home. These reousrces wi8ll be scheduled prior to surgery. Patients who need to quit smoking could receive medication to help them quit, reducing their surgical risk and improving their health outcome. The goal is to ensure that patients get all the information and resources they need to have a successful outcome.
Individuals across the province who have questions regarding this pilot project can call 1-866-670-0886 toll free or they can access the website at www.albertaboneandjoint.com and follow the links.
- How did this project begin?
The Alberta Bone and Joint Health Institute, together with the provincial government, the Alberta Medical Associaiton, and the Calgary, Capital and David Thompason Health Regions, explored how services could be delivered to improve access to hip and knee replacments within a target timeframe based on urgency.
- How can patients find out if they are eligible to take part in the pilot?
The pilot project is now completed and is no longer accepting patient referrals.
