Primary Unilateral Total Hip and Knee Replacement
Joint replacement surgery refers to the surgical replacement of the articular surfaces of a joint with a suitable prosthesis. Undergoing surgery for total hip or knee replacement can improve a patient’s quality of life and their ability to function physically, including reducing or eliminating their pain and increasing their mobility.
Ontario’s Excellent Care for All Act, 2010 (ECFAA) is a key component of a broad strategy that improves the quality and value of the patient experience by providing them with the right care, at the right time, and in the right place through the application of evidence-informed health care.
Access to hip and knee replacement surgeries has been significantly improving in Ontario. Regardless of such successes, there is always room for improvement, and demand is changing. That’s why it helps to learn across jurisdictions what works and why, so that we have ideas and options that can be implemented to help meet tomorrow’s demands efficiently, effectively and safely.
A significant amount of research has been completed both in Canada and across the world to develop and guide clinical practice. The Ministry of Health and Long Term Care consults with clinical leaders in the field of hip and knee surgery for advice and best practices. Clinical panels, including the Orthopaedic Expert Panel, have provided feedback. The Orthopaedic Expert Panel consists of experts in the field and clinicians who have identified quality targets for primary unilateral hip and knee surgeries. One of the quality targets that was approved by the Ministry and set in Ontario as the standard of care is that 90 per cent of patients are discharged directly home from acute care hospital after primary unilateral total joint replacement surgery (with arrangements for outpatient physiotherapy as appropriate).
Central LHIN and hospitals track performance on quality targets, Clinical teams implement best practice care delivery
To measure quality of care and how well we are doing, Central LHIN uses the quarterly Orthopaedic Quality Scorecard which is released to the LHINs by Access to Care at Cancer Care Ontario. The scorecard also supports hospitals and other health service providers to monitor their performance and maximize their improvement efforts.
Achieving the quality targets can be done using evidence-based care. Improvement in discharge practices and length of stay requires standardization of care and use of a clinical pathway that provides services and timelines for care through the inpatient acute hospital care stay. Patients require educational materials to prepare them for their care experience and expectations on when they will be discharged back home.
Although there is already a high level of care provided to patients having a total hip or knee replacement, there are ongoing efforts to improve access to outpatient rehabilitation and follow-up services to support care closer to home.
In fall 2012, the first LHIN-wide evidence-informed standardized care pathway for management of Total Hip/Knee Replacements was developed by the Pathways and Tools Working Group (ALC/Rehab Project) – a group of health service providers representing Central LHIN hospitals and the Community Care Access Centre. This means that people receiving a hip or knee replacement in any Central LHIN hospital will be part of the same care pathway, protocols for pre-op and inpatient care, and measuring of same clinical outcomes.
Orthopaedic Quality Scorecards
Evidence Supporting Best Practice Care after a Hip or Knee Replacement:
The findings of an Ontario Health Technology Advisory Committee (OHTAC) report determined there is no advantage to receiving inpatient physiotherapy when compared to a home-based (or outpatient physiotherapy) program for primary unilateral hip or knee replacement with an average acuity. As a result, OHTAC recommended that the health system should support the move towards home-based physiotherapy after primary unilateral hip or knee replacements. “There is high-quality evidence to support the use of home-based physiotherapy instead of inpatient physiotherapy after primary THR or TKR surgery.”
Best practice care delivery toolkits have been created by organizations such as Bone and Joint Canada to improve consistency and efficiency of care and patient outcomes.
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