A recent study by Dr. David Urbach, head of the surgery department at Women’s College Hospital in Toronto, reveals that implementing a central waitlist for hip and knee replacement surgeries can dramatically decrease patient wait times. The study looked at data from over 17,000 Ontario patients referred for these procedures in 2017. It points to an alarming lack of proper management of surgical referrals.
The research objectively compared three distinct models of waitlist management while measuring the efficiency and effectiveness of each model’s approach to patient waitlist management. These results showed that Option 3, which uses one central intake for consultations and surgeries, significantly decreased wait times. The average patient wait times were cut almost in half for most patients. This model removes patients from a centralized waiting list. It provides them access to every surgeon in their local area, cutting through the bureaucracy.
Under the central waitlist model, the average wait time in Toronto is only 146 days, down from an abysmal 257 day average. Likewise, in Ontario West, patients enjoyed a 281-day decrease, from 536 days to 255 days. These findings highlight the overall advantages of consolidating surgical referrals where possible.
Understanding the Models
The study modeled three different waitlist management scenarios for hip and knee replacement.
The second approach is for family physicians to refer their patients to evaluate various surgeons or physiotherapists located in the client’s local area. The problem with this traditional approach is that it leads to highly unpredictable wait times. Her patients relied on the time openings and the surgeons’ schedules.
The second model, though less common, has not been as widely implemented. It seeks to create a more structured referral ecosystem. That isn’t enough, it still requires a central organizing structure to truly maximize patient access.
Option 3 is consistently the best long-term option. With an improved access point, patients can be matched to a complete network of care, no longer restricted to their hometown’s offerings. Rather than receiving individualized outreach and support, they are simply put on a centralized national list linking them to the nearest available surgeon in their geographic region.
“Unless you introduce a team-based model of care, you just have to wait until a spot opens up and that could be very long.” – Dr. David Urbach
The advantages of this centralized approach can’t be overstated. It drastically reduces wait times. It tries to get at the human impact as well, pain and suffering created by long waits for surgeries.
The Shift Toward Centralized Care
Dr. Olufemi Ayeni, president of the Canadian Orthopaedic Association, has seen a major cultural change in the orthopedic field. Increasingly, centralized waitlists are being adopted by professionals. This important shift represents a broader acknowledgment that we need more innovative, integrated systems of care.
“I think there will be some openness and there’s definitely been a culture shift within orthopedics.” – Dr. Olufemi Ayeni
Yet the Ontario government is making big efforts to improve the referral process. They’ve implemented measures such as Rapid Access Clinics and a centralized waitlist management program. Ultimately, these initiatives are intended to improve the experience of patients and help ease the surgical backlog.
Dr. Mohamed Alarakhia, a family physician and the CEO of Amplify Care in Kitchener, Ontario, pointed out that effective models already flourish within the province. He was quick to point out similar successes in Canada.
“We have examples in this province of where we’ve figured it out and across the country where they’ve done central intake.” – Dr. Mohamed Alarakhia
Models like these can act as templates for other areas seeking to better their surgical referral processes.
Addressing Patient Concerns
Waiting times for hip and knee replacements is still one of the hot button issues in Canada today. At the moment, information shows that just 2 out of 3 patients are getting their hip replacement within the national optimal time of 26 weeks. This statistic is deeply alarming to healthcare professionals, as we are all too familiar with the profound effect that waiting has on the health of our patients.
“We don’t like hearing about patients who are suffering, needing pain medications. It feeds into other concerns [such as] opioid use.” – Dr. Olufemi Ayeni
Dr. Urbach recognized that many healthcare providers are scared to lose their referral pipelines if centralized, coordinated models become the norm.
“They’re concerned that they’ll lose their source of referrals.” – Dr. David Urbach
He insists that putting patients first has to come before any one professional’s self-interest.
