Hip & Knee Success at Middlesex Hospital Alliance

The success of the new Hip & Knee Program at Middlesex Hospital Alliance (MHA) was showcased recently at the Ontario Hospital Association convention in Toronto.

"We prepared a PowerPoint presentation highlighting the success we have experienced - in wait times, in patient satisfaction, in pain management - for a program that didn't even exist at our hospital one year ago," Nancy Maltby-Webster, MHA COO, says.

The Middlesex Hospital Alliance Hip & Knee Program got its start through discussions with London Health Sciences Centre (LHSC) in January 2006. The MHA approached LHSC to offer assistance to reduce wait times and deal with the volume pressures they were experiencing for Hip & Knee Replacement surgeries. "We met with them and the LHINS to develop a plan to submit to the Ministry," Maltby-Webster says. In September 2006, the Ministry approved funding for 150 joints at MHA.

"We had strong support from our partners - external and internal and including the LHIN (Local Health Integrated Network) - but our biggest challenge was in securing the surgeons to perform these operations," Dr. Paul Ferner, Chief of Staff at MHA's Strathroy site, says, "Dr. Ralph Pototschnik, a member of the LHIN Hip & Knee Priority Action Team, offered to get the program ‘off the ground' - and he's still with us!" The first surgeries were performed in December 2006. In March 2007, Dr. Pototschnik was joined by Dr. James Guy. "In only three and a half months, we completed 75 joints despite not having a fulltime Hip & Knee surgeon of our own," Dr. Ferner says. Efforts to recruit a surgeon continued and in June of this year, Dr. Samer Hanna joined the MHA orthopaedic team. Dr. Hanna came from Mt. Sinai, where he trained under Dr. Alan Gross, a leading orthopaedic surgeon in the province.

As of November 30, 2007, The Middlesex Hospital Alliance Hip & Knee Program was successful in performing 225 joints in less than one year. "Our wait times are significantly below the Ministry target and the provincial average," Mike Mazza, CEO at MHA, says. For example, during August to October 2007, the Ministry target wait time for a Hip or Knee replacement was 182 days; MHA's time was 70 days for knees and 67 for hips. The provincial average during this same time was 291 days for knees and 210 days for hips.

"The program has benefited from the establishment of an ‘interdisciplinary care pathway' which creates a team of internal and external partners to guide a patient through the experience. These partners include MHA volunteers, our physiotherapy department, pharmacy, surgical nurses, the arthritis society and the CCAC. Eighty-seven per cent of our Hip & Knee patients meet discharge expectations, which generally means they return home after a shorter than average hospital stay, with pain managed and on target with their mobility," Maltby-Webster says.

The success of this team approach is seen in the excellent wait times but also in the reported satisfaction from patients. The first 150 patients were interviewed at two and then at six weeks after their surgeries. They were questioned about pain, mobility and overall satisfaction with the experience. More than 90 per cent of patients reported an "excellent" experience.

The MHA team is receiving some well-earned praise with this program, including from the Southwest LHIN, Mazza says, "It shows how a smaller hospital can respond quickly and successfully, working in partnerships to meet the needs in our community."

Connecting with the Future of Care

Hip & Knee Success at Middlesex Hospital Alliance