1. Person-Centred, High-Quality, Safe and Sustainable Health and Wellness for Nova Scotians

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A focus on wellness:
Improving joint replacement access and care for Nova Scotians

John Oliver

John Oliver of Wallace, Nova Scotia is among many patients benefitting from new resources and a new approach to joint care

By Krista Wood

“I thought I read someplace that there was a guarantee of six strokes.”

A month after having his knee replaced, John Oliver jokes about his expectation that the surgery will improve his golf game. The Wallace resident is focused on his recovery, following the exercise plan offered by his health care team.

“If you follow them (exercise plans), you can see progress; you can see the progression of the knee coming back. How far you get with it, I fully understand is totally up to me.”

He has set his sights on returning to golfing on the North Shore this summer.

Oliver is among many patients benefitting from new resources and a new approach to joint care being introduced as part of Nova Scotia’s hip and knee action plan, including several weeks of group pre-habilitation.

Born from the need to address high wait times for joint replacements, the plan is helping improve access and care, with the goal of achieving the national six-month benchmark. It offers patients enhanced education and support to help them get the most from their surgery.

For some, it could mean delaying or even avoiding surgery altogether.

“The big thing that I have noticed, is the way in which the team concept has been brought to play, so that as a patient, you have a whole team of support around you. The occupational therapists, physiotherapists, and nurses, all of whom help you progress to the next step,” Oliver said.

“To get first-hand, one-on-one help with what you are going to go through, and what you are going to go through after, is invaluable.”

The plan includes new resources, including four additional surgeons and anesthesiologists, as well as more than 50 additional full-time equivalent (FTE) roles in nursing, physiotherapy, occupational therapy and more.

But the aim is not simply to complete more joint replacements.

For teams implementing the new model, it represents a shift in how Nova Scotia thinks about and cares for joint replacement patients.

“Patients with hip or knee issues are not necessarily sick, so why treat them like they are?” said Dr. Marcy Saxe-Braithwaite, NSHA’s senior director of perioperative (surgical) services.

“Our model is helping us make wellness a bigger focus in the care we offer before, during and after surgery. We believe it will give patients the best chance at a successful surgery; a faster, more complete recovery, and a more positive overall care experience.”

Past joint replacement patients have been invited into the planning process, working with the team to map their care journey and identify opportunities for improvement.

Within the first several months of launching the action plan, clinicians adopted a new provincial clinical pathway to guide joint care and support greater consistency.

“This was an important first step,” said Dr. Michelle O’Neill, orthopedic surgeon and chair of the Orthopedic Working Group. “Regardless of where they live, we want all of our patients to be able to rely on the same quality of care, aimed at helping them live their best, most active lives possible.”

Rather than referring patients to individual surgeons to await a consultation, joint replacement candidates are first channeled to enhanced and expanded orthopedic assessment clinics across the province.

Launched in the fall of 2018, the aim is to offer patients a timely initial assessment by a team that assesses their need and readiness for surgery, and connects them with the supports needed to optimize them for surgery. That includes:

  • • an exercise and physiotherapy program to increase their strength and mobility;
  • • supports to achieve a healthier weight and stop smoking if able;
  • • advice to make their home safe and accessible ahead of their surgery and for their return home.

In November 2018, teams began transforming the care patients receive after surgery as well.

“Mobility and recovery go hand and hand and we know movement plays a big role in reducing the risk of complications such as blood clots,” said Sally Blenkhorn, manager of rehabilitation services and the orthopedic assessment clinic at Valley Regional Hospital.

“Our wellness model emphasizes getting patients moving early and often after surgery.”

Following surgery, patients recover in special chairs that allow them to get up and move more easily than from a hospital bed. Most patients take their first steps the day of their surgery and join a group activity class early the following day.

Patients are asked to bring in running shoes, T-shirts and shorts to wear, instead of hospital gowns.

According to Blenkhorn, small changes like this can help change the “I’m sick” mindset, encouraging patients and motivating them to keep moving to resume their activities of daily living.

While patients have traditionally been admitted for two to three days, the goal is to move toward most returning home the day after surgery, with the right support, when it is safe and appropriate. Early data shows that lengths of stay are decreasing following these surgeries.

Some otherwise healthy patients may even return to the comfort of their own home the same day as their surgery. Patients with other health issues and needing extra support at home may stay longer.

“It’s a journey, not a race, but we are excited by the early progress made possible by our teams,” Saxe-Braithwaite said.

“We are optimistic that our approach will improve the quality of care and quality of life of our patients, while helping us achieve and sustain the national benchmark. This model could hold promise for other types of patients as well.”

Learn more about NSHA’s Hip and Knee Action Plan at www.nshealth.ca/hip-and-knee.