The Holland Centre – PROVINCIAL CENTRE OF EXCELLENCE
On behalf of the Holland Centre
Interprofessional Team – February 6th, 2013
Referral
Sent to
Individual
Surgeons
(“Batched”)
No system for
tracking
referrals or
wait times
Surgical
Consult
40% don’t want/need
surgery
• Long waits
• No time for questions
• Limited education on
treatment options
Preadmission
Clinic
12-15% not fit
for surgery
Surgery
delayed or
cancelled
Surgery
Post
Operative
Follow up
50% wait > 220
days for surgery
Surgeons unable to
keep up with volumes
Length of stay?
Long clinic waits
Destination?
Limited patient
education
No room for
new patients
Overview

Major Restructuring of Outpatient Services

New Benchmarks, New Processes

Key Elements:







Non-physician based model of care
Centralized electronic referral management
Emphasis on patient choice and empowerment
Selective referral to surgeons driven by defined criteria
Team approach to post op follow-up: increased capacity
Community partnerships to support active healthy living
Early Ongoing Evaluation; Research Strategy
Shared Orthopaedic Foundation
Independent & Overlapping Roles
Physiotherapist
Orthopaedic
Surgeon
Research Studies :
Attain high diagnostic accuracy; Comparable to surgeons;
Performed better than other HCPs
Childs 2005, 2007; Moore 2005; Gardiner 2002; Aiken 2008; Razmjou 2013
1. Determine need for new
model of care
2. Define patient population
and current model
3. Identify stakeholders and
recruit team
High demand, system burden
Traditional surgeon roles
Administration, surgeons,
patients, physiotherapists
9. Long term monitoring
System-wide
Reconfiguration with
APP Role
Evolve and expand role to match
needs
8. Evaluate APP role and new
model of care
Structure- Process-Outcome
Surgeon collaboration
is key!
4. ID priority problems and
goals to improve model of care
Goals: maximize human
resources, improve efficiency
5. Define new model of care;
obtain stakeholder consensus
Developed Advanced Practice
Physiotherapist (APP) role
7. Initiate APP role
implementation plan
6. Plan implementation
strategies
PLAN-DO-STUDY-ACT cycles
Identify barriers and facilitators;
Medical Directives extend scope
Robarts et al. Healthcare Quarterly 2008
Physician Referral
Central
Intake
Assessment
and
Optimization
Surgery
APP triages APP provides initial APP provides
earlier post op
all referrals
assessment
in 2 days
and treatment plan intervention
Non surgical path:
Treatment and re-entry
options. Tele support
Long-term
Follow up
APP performs all
routine follow up
and tele support
IDs need for new
joints/revisions
Physician Referral
Central
Intake
Assessment
and
Optimization
250 referrals
per month
230 visits/month
e-Tracking;
Wait 1
reporting
12,000 visits
(2007)
Surgical
Long-term
Consult /
Follow up
Surgery
Patients better
400 patients/month
prepared.
 Cancellations
High patient
3-4 days LOS
satisfaction.
85 to 90% go
 ACCESS
home
Non surgical path:
30% defer consult;
community partnerships
INTAKE ASSESSMENT
POST OP FOLLOW UP
Comprehensive
Individualized
recommendations
 Choice of surgeon
 Treatment options
 Time for questions
 Re-entry options
 Jump-start on health issues




Decisions based on
standardized outcome
measures
**Kennedy, et al. Physiotherapy Can 2010





HIGHLY SATISFIED**
Prompt Telephone Support
Improved access to clinics
Education/Time for
questions
Enhanced monitoring
Optimization of function
http://www.youtube.com/watch?v=qU
krYz-xXEY
CBC’s White Coat, Black Art with Dr.
Brian Goldman: Unnecessary Surgery
Show – aired November 3rd 2012 :
http://www.cbc.ca/whitecoat/episode/2012/11/03/unnecess
ary-surgery-out-from-under-the-knife/
Holland Centre Wins Prestigious National 3M Award:
http://sunnybrook.ca/content/?page=Focus_MSK_Prog_HKAP_Home