Surgeons perform about 50,000 knee and hip replacements in Ontario each year, and as the population ages that number will only go up. A multi-hospital collaboration in Toronto is helping lower the cost of this operation and improve recovery times.

[ News Release 2009-30 ]

Hospital bed spaces can be hard to find in Ontario, and this translates into long wait times for elective surgeries such as joint replacements. In 2005, 23 healthcare organizations in the Greater Toronto Area joined together to form the Total Joint Network. Their goal: reduced wait times, shortened patient recovery and savings for the taxpayer.

Led by Dr. Nizar Mahomed, head of Orthopaedic Surgery for the Toronto Western Hospital University Health Network, the group began streamlining patients into two recovery programs. One group spent 5 days in an acute care hospital then returned home and received regular visits from a rehab specialist. The other group received three days of acute care followed by seven days of inpatient rehabilitation.

Testing revealed clear advantages to the new model. Using the model, the number of inpatient rehabilitation days decreased by about 40%, and the acute care length of stay also decreased approximately 30%. Meanwhile, patient recovery and satisfaction was just as good as before, while saving more than $10 million annually in healthcare costs in the Greater Toronto Area.

"We ensured that patient safety and clinical outcomes were maintained, satisfaction was high, and system cost savings were realized," said Mahomed. "It was a nice example of how a significant number of organizations can work together in a collaborative fashion to lead to evidenced-based improvement in healthcare delivery."

Not content to just overhaul elective hip and knee replacement surgeries, the group then focused their attention on hip fracture patients who Mahomed said were "a marginalized and underserviced patient care area."

The success of their first project attracted more healthcare organizations for the second experiment, 35 acute care hospitals in all. And, they set aggressive goals to get the patient into surgery within two days, to in-patient rehab within five days, and have the total rehab stay not exceed 35 days. Previously the average wait to get rehab was 10-12 days and the average rehab stay was 42 days.

In the end, Mahomed's plan worked even better than expected. Because patients didn't have to spend days sitting in a hospital bed waiting for surgery, they were stronger and in better condition at the time of their operation. As a result, the group managed to reduce the overall rehab stay to just 28 days. This shorter and, ultimately more effective treatment period meant that 20% more patients returned to their pre-injury health status. Their return to health is saving the province about $17 million per year by helping hip fracture patients avoid long-term care facilities.

"The results were actually better than I had anticipated when we first started this," said Mahomed. "I was hoping that at least we could have some improvement in how we deliver care and hopefully have better access for our patients, but the outcomes were far better than that. It really is an example of how you can achieve a win-win for all of the stakeholders in this particular area of healthcare."