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Elective Unilateral Knee and Hip Replacement Project

In April 2005 twenty three healthcare organizations across the Greater Toronto Area (GTA) including 10 acute care hospitals, 5 rehabilitation hospitals and 8 community care access centres (CCAC), joined together with a goal of streamlining the healthcare system so that patients who were scheduled to undergo a knee or hip replacement for the first time received the best care from the first visit to the Surgeons office to recovery back home.

Total Joint Network Partner Organizations

The following organizations were partners in the Unilateral Primary Hip and Knee Replacement Project:

Acute Care Hospitals

• Humber River Regional Hospital
• Mt. Sinai Hospital
• North York General Hospital
• The Scarborough Hospital
• Scarborough Centenary/Rouge Valley
• St. Joseph’s Health Centre
• St. Michael’s Hospital
• Sunnybrook and Women’s College Health Centre
• Toronto East General Hospital
• University Health Network

Rehabilitation Hospitals

• Bridgepoint Health
• Providence Healthcare
• St. John’s Rehabilitation Hospital
• Toronto Rehabilitation Institute
• West Park Healthcare Centre

Community Care Access (CCAC)

• Community Care Access Centre of Peel
• Community Care Access Centre of York Region
• Durham Access to Care
• East York Access Centre
• Etobicoke and York Community Care Access Centre
• North York Community Care Access Centre
• Scarborough Community Care Access Centre
• Toronto Community Care Access Centre

Other Partner Organizations

• GTA Rehab Network
• Ontario Joint Replacement Registry (OJRR)
• The Arthritis Society, Ontario Division

Integrated Model of Care
The model of care that was designed for people who are having single joint hip or knee replacement surgery.

The Orthopaedic team at each hospital assisted in developing and implementing this model of care including the following professionals:

• Surgeon
• Anaesthatists
• Nurses
• Physiotherapist
• Occupational Therapist
• Dietician
• Social Worker/Discharge planner
• CCAC Case Manager/Care Coordinator

Prior to surgery patients provided the Orthopaedic team with information about their health based on 3 standard criteria: medical, functional and social status. Using this information the team decide where the patient should receive their therapy following the surgery and provide them with the appropriate education. As part of the initiative the Total Joint Network also worked with The Arthritis Society and the GTA Rehab Network to create a web site that provides additional educational information for patients. This can be accessed at www.myjointreplacement.ca

With the majority of patients meeting the criteria to receive their therapy at home many patients also receive a visit from a physiotherapist in their home prior to the surgery. During this visit the therapist talks about safety, equipment and exercise. The few patients that require therapy in a Rehabilitation Hospital to recover from their surgery have a referral to the hospital made when they first see the surgeon and receive 7 days in the rehabilitation hospital.

Results of the system change
The change that occurred through the implementation of the Integrated Model of Care for elective primary hip and knee replacements has been successful in improving the care for over 6,000 patients across the Greater Toronto Area. To date in 9 of our 10 hospitals we have achieved an average of 64% of patients being discharged directly home where they have received their care through the CCAC or out patient therapy. In order to track the clinical effectiveness of the new model an evaluation study was completed following 529 patients through their surgery and their recovery process over a 1 year period.