Fern: "The amount of pain I was in, I didn't realize how extreme, because you never really see yourself,
but I had my friends have told me how I walked and they couldn't believe how I moved, and they
felt so bad for me, because I just looked like I was in a lot of pain,
and I realized that my quality of life had just diminished, and
it greatly needed to change because I wanted it back.
Because when you're healthy you think you can conquer the world, but once you've got that
factor where you don't have your health, you don't have everything."
Dr. Rose: "Patients have been concerned for quite some time about lengthy wait lists for surgery,
particularly for hip and knee replacement surgeries.
Some patients prior to 2006, 2007 were waiting a year or more than a year
in some situations, and Toronto Central then wanted to do something more about access to
the orthopaedic surgeon. How long does it take from the time, if
you're a patient when you see your family doctor, to you actually get in to see the orthopaedic surgeon?"
Dr. Gollish: "So when we looked at how to look after people better, there were several things that we
we needed to look at, and one of them was access to care. Access to care doesn't mean access to surgery,
necessarily. There's a lot of of emphasis on what we call the "wait-to",
the wait time from consultation to surgery date. But that
isn't the only access to care that's important for people with arthritis, so when we looked
at developing a new model of care, we looked at how we could help people
with hip and knee arthritis
to received appropriate care in a timely manner by the appropriate provider,
and that doesn't necessarily mean the appropriate surgeon,
it means the appropriate provider.
So we wanted people to have access to both surgical a non-surgical care in a timely way, and
we also wanted people to have some choice in terms of how they perceive that care."
Susan: "So, one of the first things we had to do was increase capacity in the system.
The system was just overburdened, surgeons were really having a difficult time seeing additional
new patients in clinic, patients we knew were frustrated with clinics and with wait times
in clinics. So we listened to
patients, and one of the first we did was that we
the introduced physiotherapists into the post-operative outpatient surgical clinics,
and then through a three-month training program
we were able to then expand the role,
and have the physiotherapists see patients in the assessment centre, so, as
an initial visit to the Holland Centre.
So, patients are now seen by advanced practice physiotherapists,
who perform a comprehensive physical examination,
and do the necessary diagnostic tests
and then talk with the patient about whether or not they need surgery, whether or not they want surgery.
And I really think that it's that conversation with
the patient; that's where we add value."
Bryan: "Osteoarthritis was something that I had been living with.
I got in touch with the Holland Centre,
asked for an appointment, wanted to follow up on the x-ray, and was seen
in very quick time. I was impressed by that.
My sense there is that I was being seen by a team, and at this point the lead on the team
was the advanced practice physio, but the back-ups to the team was the front office,
was the receptionist, was the person scheduling, was the medical clerk, and sitting just in
the background were the physicians on a need-to-know basis.
So, I had the sense of dealing with a very high-performing team.
It was very impressive."
Dr. Gollish: "Now when patients come for consultation, they've been through the assessment centre,
so we can review what the advanced practice physiotherapist has found on physical exam,
if they've seen the nurse, we know what their general health condition is like, so
we know if there are any barriers to their surgery.
But, the main issue is that I can spend more of my time, and we can all spend more of our
time, discussing with the patient
the surgery--informing them of the risks and benefits of surgery, what their rehab and
convalescence will be like--
so it allows us to use our time more efficiently
to communicate the important things to the patient relative to their surgical experience."
Susan: "By introducing an electronic referral tracking system we now have a way of
collecting important information about each step of the patient's referral through the system.
Prior to this it really was a black hole. Referrals were
sent into individual surgeon offices
and there was no information provided back to family physicians as to when that referral
was received and what was happening with that referral.
Now we have a very coordinated system, and that coordinated system
also provides patients with the option
of selecting the next available surgeon, or going with a surgeon that
has a longer wait time, and then patients can make that choice."
Dr. Gollish: "The patients are very happy with the team approach. They see that they have
multiple caregivers that can answer specific questions for them, relative to the area of
expertise of the care provider,
so that they know the surgeon can answer certain things, and the advance practice physio can answer
different things, or provide them with different assistance,
the same with the occupational therapist as needed. So we have
a team approach now that the patients see as very helpful to them,
in terms of accessing the appropriate information."
Bryan: "They were seamless with me,
and the hand-off to the surgeon for my consult was timely, effective. . .
I didn't have to repeat a whole whack of information. And, uh, again,
just an elegant, seamless experience.
It's given me great optimism. I haven't had the surgery yet, I have a
date this summer for it, and I'm actually looking forward to it."
Barry: "So much of what we accomplish around Sunnybrook is based on teamwork,
and this new model of care is just a great example of Sunnybrook teams coming together to improve
the quality of care.
Now, there's a number of benefits of this initiative. Clearly this has improved access,
but most importantly, the patients appreciate this; they really notice what difference it makes.
This is just a great example of Sunnybrook's innovation,
and for us, what it means to be there when it matters most."