Conference Presentation

The following is a text version of the presentation given at the Conference on Timely Access To Health Care, held February 8-9, 2007 in Toronto, Ontario.

Orthopedic Access Improvement Initiatives in the Winnipeg Regional Health Authority

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Presentation Outline

• Acknowledgements
• Framing the Challenge
• Is it just a matter of more volume?
• Managing the Shape
• Great variability in # patients on individual surgeon's WL
• Rationalization Strategy in > 41 week wait group
• Pre-Habilitation
• Projecting Additional Volume Requirement
• Increase Volumes without displacing others
• Effects of Interventions
• Effect of Segmenting & Increased Volumes
• Effects on # Waiting
• Summary of Strategies
• Conclusions

Acknowledgements

Minister and Deputy Minister of Health CEO Winnipeg Regional Health Authority

Framing the Challenge

Is it just a matter of more volume?

Managing the Shape

Great variability in # patients on individual surgeon's WL

Rationalization Strategy in > 41 week wait group

1. Validation of paper list, removal of
   records.
2. Segmentation into categories by phone
   • Willing and Fit
   • Willing but not Fit
   • Wish to Delay (some asked to be removed)
3. Negotiated reassignment with patient
   consent (If declined, informed C or C2)
4. Informed Optimization in one
   hospital group (Pre-Habilitation).
   Further segmentation into A,B & C.
5. Chronological booking with offices
6. Booking ahead.
7. Calculation of resources per
   surgeon to achieve intermediate
   benchmark of 41 weeks.

Pre-Habilitation

• Offered to patients in one
  hospital (Phase I)
• Collaborative Practice
  • Medical
  • Nursing
  • Physiotherapy
  • Dietitian
  • Occupational Therapy
  • Social Work
  • Pharmacist
• Questionnaire
• Informed Consent

Projecting Additional Volume Requirement

By Surgeon & by Hospital

Increase Volumes without displacing others

• Maximize throughput in present arthroplasty resources (E. Bohm)
  • Intake Process (Clinic Optimization)
  • Double Rooms
  • Physician Assistants
  • Prioritize Unused Slates to Arthroplasty
• Allocate additional dedicated Arthroplasty Slates with minimum throughput requirements
• Preoperative Optimization (Pre- Habilitation)

Effects of Interventions

Comparing Jan. 06 & Dec. 06

Effect of Segmenting & Increased Volumes

Effects on # Waiting

Summary of Strategies

• Validating Waiting Lists
• Segmenting into A, B & C. Re-Entry
• Introducing Pre-Habilitation (Optimization)
• Streamlining Flow-Through Process
• Calculating & Implementing Required
  Additional Volumes (not displacing)
• Managing OR Scheduling and Patient
  Flow with Offices

Conclusions

• Backlog has been reduced
• Waiting Times have been reduced
• System has been changed to prevent
  recurrence
• These methodologies are now being
  extended to other priority areas