Time from referral to consult reduced by 80 per cent

Story by Tara Grindle; photo by Shelly Willsey

Agnes Leonhardt knows firsthand that, when you need hip surgery, sooner is always better than later.

The 57-year-old Edmonton woman underwent two hip replacement surgeries last year. She was referred to the Edmonton Musculoskeletal Centre (hip and knee clinic) in January and underwent her surgeries in May and November.

“My hips deteriorated really quickly and I had no quality of life. I used to crawl up the stairs and cry before I went to work in the morning,” says Leonhardt, who was on strong narcotics to deal with the severe pain.

“Surgery was life-changing. It took away my pain.”

Alberta Health Services (AHS) is supporting wait time reduction initiatives designed to help patients requiring hip and knee surgeries get the care they need sooner.

Patients seeking pre- and post-operative care at Edmonton’s only hip and knee clinic have seen their wait times cut by 80 per cent thanks to a wait-time reduction initiative jointly supported by AHS and other partners.

In a one-year period, the wait time between referral to the surgeon-owned Edmonton Musculoskeletal Centre and initial consult has been reduced from 10 months to less than two months.

“We’ve made changes that have really helped us improve care for our patients,” says clinic surgeon Dr. Paulose Paul. “By becoming more efficient, we have dramatically lowered our wait times, and this means less frustration and better results for our patients.”

The wait time reductions at the hip and knee clinic, which supports more than 3,700 patients needing hip and knee joint replacements annually, are a result of its participation in Alberta AIM (Access. Improvement. Measures.).

Using AIM principles, the clinic found efficiencies in all parts of its operations. For instance, staff time was dedicated to clearing up the backlog of 689 referrals waiting to be scheduled and streamlining the process for booking referrals.

As a result, patients now spend less time and effort to book their first appointment, says clinic executive director Jane Squire Howden.

“We used to get up to 30 calls a day from patients wondering if we had received their referral,” says Howden. “We aren’t getting those calls anymore because referrals are being entered within 24 hours and patients called within the week for their first appointment.”

Changes such as those being made at the hip and knee clinic are contributing to a steady decrease in Edmonton Zone wait times for hip and knee surgeries.

The wait time for 90 per cent of the people who require a hip replacement was down to 32.9 weeks from April to December 2012, compared to 51 weeks over the same period the previous year, a 35 per cent improvement.

The wait time for 90 per cent of the people who require a knee replacement was down to 38.8 weeks from April to December 2012, compared to 57 weeks over the same period the previous year, a 32 per cent improvement.

Continued wait time improvements for hip and knee replacements were expected in the final quarter of 2012-13, which ended March 31. AHS’ year-end performance results for 2012-2013 will be released next month.

Alberta AIM director Steve Clelland says measurement is a critical part of the improvement process.

“AIM helps identify where and how improvements can be made but, more importantly, the program builds capacity within teams to test changes and ensure they’re having a positive impact,” says Clelland. “As a result they know where they started and how far they have come in reaching their goals.”

The clinic also credits the support and direction of the AHS Bone and Joint Health Strategic Clinical Network (SCN) in moving improvement initiatives forward and enhancing the quality of care for patients. SCNs are provincewide teams comprised of health care professionals, researchers, community leaders, patients and policy makers, who are dedicated to developing care pathways in a specific area of health that will enhance the patient experience, improve outcomes and standardize care delivery across the province.

Alberta AIM is intended to help physicians and their teams increase access through improved efficiency, and is supported by AHS, the Alberta Medical Association, Alberta Health, Toward Optimized Practice and primary care networks.

Edmonton Musculoskeletal Centre is also supported by the Alberta Bone and Joint Health Institute (ABJHI), an independent organization that collects data across the province and standardizes care. The ABJHI helps the clinic verify its data and measure its success on an ongoing basis.