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Evolving New Practices in Hip & Knee Arthroplasty: It Takes A - - PowerPoint PPT Presentation
Evolving New Practices in Hip & Knee Arthroplasty: It Takes A - - PowerPoint PPT Presentation
Evolving New Practices in Hip & Knee Arthroplasty: It Takes A Team! CCHSE National Healthcare Leadership Conference June 11-12, 2007 Toronto Focus of Presentation Toronto Central LHIN is developing a new model of care for hip &
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Sunnybrook Health Sciences Centre Holland Orthopaedic & Arthritic Centre
2,400 Hip/Knee Replacements Annually ALOS 4.6 days, 65% discharged home 35% inpatient rehab, ALOS 5.6 days 4 Operating Rooms 70 Beds (48 acute and 22 short-term rehab) 2 Special Care beds 75% of patients from outside Toronto Central LHIN
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TC LHIN Hip & Knee Replacement Program
Central Intake Assessment Centre Surgeon Consult Surgery Post-Op Discharge Follow-Up Referring Physician
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Principles for Model of Care
Patient Centred Interdisciplinary Evidence-Based Quality & Efficiency Integrated Continuum Partnerships
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Framework for New Model of Care
Process & Role Redesign Collaboration/Consensus/Communication Assigning Champions Human Resource Strategy Information Systems/Technology Physical Facilities Evaluation
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Hip & Knee Arthroplasty
New Roles
Nurse Practitioner, Acute Pain Service RN First Assistants Anaesthesia Assistants (RN’s & RT’s) Nurse Practitioner, Postop Medical Management Critical Care Rapid Response Team Advanced Practice Physiotherapists
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Central Intake & Assessment
Role:
- Intake Centre – Triage Referrals (2 Days)
- Assessment Centre (Appointment within 2 Weeks)
- Comprehensive Physical Assessment
- Education & Treatment Plan
- High level Nursing Assessment if Surgical Candidate
Impact:
- Timely Access based on Urgency
- Patient Choice – 20% of patients choose 1st available appointment
versus specific surgeon
- Patient Satisfaction is high
- 30% of Patients deemed to be non-surgical candidates or decide to
defer surgery and pursue other options - reduced time by Orthopaedic Surgeons in seeing non-surgical candidates.
Advanced Practice Physiotherapist Registered Nurse (If Surgical Candidate)
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Surgery
Role:
- RN FA - technical assistance at surgery and support the
perioperative care process.
- Replace GP Assistants
- Anaesthesia Assistants (RN’s & RT’s) – work collaboratively
with Anaesthetists to improve efficiency and quality of care.
- Impact:
- 85% of patients receiving regional anaesthesia
- Reduced anaesthesia-related complications
- 15% reduction in OR time
- Reduced length of stay
- Improved patient experience.
- RNFA approx. 50% cost of GP Assistants
RN First Assistant Anaesthesia Assistant (RN’s & RT’s)
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Post-op Management
Role:
- Nurse Practitioner – timely postoperative assessment and
treatment for medical problems.
- Critical Care Rapid Response Team – available Mon to Friday
during working hours to respond to urgent patient management concerns. Impact:
- Improved quality of care & safety.
- Improved communication & consistency in care and outcomes.
- Reduced need to transfer to higher level service ie. Critical
care.
Critical Care Rapid Response Team Nurse Practitioner
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Pain Management – Acute Pain Service
Role:
- Anaesthetist & Nurse Practitioner work collaboratively to supervise
postoperative pain management.
- Multimodal pain management
- Standard order sets
- Education/certification of care team members.
Impact:
- Rapid recovery, with fewer complications.
- Reduced length of stay.
- Improved patient satisfaction
Anaesthetist Nurse Practitioner
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Follow-Up After Discharge
Role:
- Advanced Practice Physiotherapists manage routine follow-up
visits after discharge from Hospital Impact:
- 80% of patients managed by APP versus Orthopaedic
Surgeon
- Systems savings – Salary of APP vs Fee for Service of
Orthopaedic Surgeons
- Allows surgeons to invest time in surgery
Advanced Practice Physiotherapists
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Implementation Challenges
No formal role recognition through Colleges ie. Advanced Practice
Physiotherapists, Extended Class Nurses – Acute Care
Limited/No formal training programs ie. Advanced Practice
Physiotherapists, RN First Assistants, Anaesthesia Assistants
Legislative barriers – Limited recognition of extended class roles Limited funding – primarily through demonstration projects. Limited policy framework – role profiles, medical directives, etc. Uncertain liability issues
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Early Evaluation
Improved Access, Shorter Wait Times Shorter Hospital Stays Reduced time spent by Specialist MD’s in routine
care (ie. Surgeons, Anaesthetists)
High Patient Satisfaction System Savings vs Costs
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The Future
Long term evaluation of model Specialists vs Generalists Clarity of Roles – Integration vs Overlap Alignment with Interprofessional Care Models Sustainability:
Positive for recruitment & retention Dependent on qualified professionals Requires education/training resources Dependent on funding of the model
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