Coordinated referral and team-based care models show promise in reducing surgical wait times

Coordinated referral and team-based care models show promise in reducing surgical wait times

How can we reduce wait times for much-needed hip and knee replacement surgery in Canada? Coordinated referral and team-based care models show, according to studies published inCMAJ(Canadian Medical Association Journal)https://www.cmaj.ca/lookup/doi/10.1503/cmaj.241755.

In Canada, there are long wait times for elective surgeries such as hip and knee replacements, which can lead to worsening pain and mobility problems and impact overall health. Canada performs well in international comparisons of health care systems based on wait times. To address this problem, some Canadian provinces are experimenting with private provision of some surgeries, but there are other potential solutions.

“…Other policy approaches, such as single-entry referral models and team-based care, could significantly reduce surgical wait times and improve geographic and socioeconomic inequalities in wait times, which could worsen with other types of interventions,” writes Dr. David Urbach, chief of surgery and director of perioperative services at Women's College Hospital and professor at the University of Toronto, in the department. “If the potential benefits of these care models were better quantified, policymakers and health authorities could more convincingly advocate for their implementation, which faces strong opposition from some health system participants.”

Researchers compared 3 models of care in the study to determine if there is a better option to deliver surgeries more quickly. The research included all patients referred by a general practitioner or family doctor to an orthopedic surgeon in 2017 for non-existent hip or knee replacements and for whom there was complete waiting time data. The model simulations were based on data from 17,465 surgeries on 17,132 patients, 7,783 referring physicians, 274 surgeons, and 71 hospitals from 5 regions in Ontario.

The 3 care models involved a single entry referral or “central admission,” whereby all patients in 5 regions each are pooled and recruited for consultation with the nearest specialist. Team-based care, in which patients enter a regional pool after consultation and queue for surgery in their area; and a fully integrated model where patients are pooled into a queue to be seen by the next available surgeon in their region and then enter another queue for surgery by the next available surgeon in their region.

Both team-based and fully integrated models had much greater impact on reducing wait times than the single-entry referral model.

"Our findings support strong support for the implementation of both individual referral models and team-based care as a regional solution to the problem of long wait times for elective surgeries in Canadian healthcare systems, as well as an effective strategy to improve equity in access to healthcare services. Implementation of these models requires strong leadership between healthcare leadership and active participation in the surge crisis," write the authors.

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