BY NORM TOLLINSKY
The Timmins and District Hospital joint assessment centre began operating in February and is already putting a dent in the three and a half year waiting period for hip and knee replacement surgery.
“Six months ago, before the joint assessment centre opened, we were sitting at 1,280 days,” said hospital president Roger Walker. “We’ve been able to bring that down 15 per cent and, once our second surgeon joins us in December, we’ll be able to bring it down substantially below the 1,100-day mark.”
Timmins District currently has one full-time orthopedic surgeon, Dr. Robert Lafontaine, and two others providing some support, including a locum and a surgeon who was full-time but now practises on a part-time basis.
Patient flow is expedited by advanced practice physiotherapist Raphael Delli Quadri, who performs a screening and assessment function, redirecting patients who don’t require surgery or aren’t ready for it, as well as those who do require a hip or knee replacement but aren’t prepared to wait two or more years to have the procedure done locally.
“Before the joint assessment centre, I spent a lot of my time in my office seeing patients who were referred for hips or knees, but when I examined them, they had sciatica. I would spend a half hour with them, but they really needed to see a back specialist. Now, the advanced practice physiotherapist weeds them out.”
Forty-one per cent of patients referred to the joint assessment centre end up seeing an orthopedic surgeon for a total hip or knee replacement, while 59 per cent are non-surgical.
Options
“If the patient is not ready for surgery, we can talk about different options such as cortisone injections, physiotherapy, exercises, hydrotherapy, weight loss, a brace or mobility aids,” said Delli Quadri.
Prior to the establishment of the joint assessment centre, patients who didn’t want to wait years to have joint replacement surgery performed in Timmins would usually return to their family physician for a referral to an orthopedic surgeon in Toronto or elsewhere. Now, referrals are co-ordinated through the joint assessment centre.
“The intention is that the five joint assessment centres in northeastern Ontario will operate collaboratively to identify opportunities for people to receive the services they need more rapidly than is possible within the municipality or area that the local hospital serves,” said Walker.
Network
Timmins and District Hospital was in the process of setting up a centre when the Northeast LHIN got involved and went to bat for a region-wide network. A joint assessment centre opened in Sudbury last year and, by the end of 2011, centres in North Bay, Sault Ste. Marie and Parry Sound are expected to be in operation.
(In the northwest, a joint assessment centre has been in operation at Thunder Bay Regional Health Science Centre since January 2009.)
The hope is that more patients in need of hip or knee replacement surgery can be accommodated on a timely basis within the region.
“Having the procedure done in Toronto isn’t the best option for every patient, especially if there are other health issues,” said Delli Quadri. “This way, we can offer treatment that’s closer to home.
“There are surgeons with shorter wait times, so if patients are medically able and fit, and can go somewhere else, we try to make it as seamless as possible for them.”
Provincially, the average wait time for joint replacement surgery is 382 days for knees and 386 days for hips, said Walker. “In the Northeast LHIN, we’re slightly above that.”
The joint assessment centre in Timmins is freeing up the hospital’s surgeons to bemore productive and bringing wait times down from their stratospheric heights, but getting close to the provincial average would require four or five orthopedic surgeons, more operating room time and dedicated nursing staff, none of which is likely to happen any time soon.
The good news though is that the wait time for appointments with the advanced practice physiotherapist is currently one week. Prior to the establishment of the centre, patients could wait six to eight months for an appointment to see an orthopedic surgeon - in some cases only to discover that they didn’t require surgery.
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