Thunder Bay

Thunder Bay's Rapid Access Clinic for hip, knee conditions cuts wait times from years to weeks

The Thunder Bay Regional Health Sciences Centre is leading Ontario with its Rapid Access Clinic, an innovative new model for treating people with hip and knee conditions. Wait times for consultations have been cut from nine months to just two to four weeks, and most surgeries are completed in less than six months.

"This is the most modern arthroplastic program in the world,' says one of clinic's 4 orthopedic surgeons

Orthopedic surgeon Dr. Dave Puskas (far left), Rapid Access Clinic program director Caroline Fanti (left), patient Laurie Horlick (centre) and orthopedic surgeon Dr. Travis Marion (right) stand in a treatment room at the innovative new clinic at the Thunder Bay Regional Health Sciences Centre. (Cathy Alex/CBC )

The Thunder Bay Regional Health Sciences Centre (TBRHSC) is leading the province with its Rapid Access Clinic, an innovative new central intake and assessment model for treating people with hip, knee and spine conditions, says Caroline Fanti, the program director.

"This is the most modern arthroplastic program in the world, it really is," says Dr. Dave Puskas, one of the northwestern Ontario clinic's four orthopedic surgeons, and the co-founder of the program with Fanti.

Patients are referred by their family doctor to the clinic, which then acts as a one-stop shop for consultations with orthopedic specialists and ultimately surgery if required.

Once enrolled in the program, the patient is assessed and then agrees to be cared for by the next available doctor from a pool of orthopedic surgeons, who also take turns working in Dryden, Fort Frances and Kenora.

'More streamlined care for patients'

Putting aside the natural competitive instinct between surgeons was key to developing the program, said Puskas.

"We're kind of territorial but my partners are very progressive and they listened to this as an idea and they chewed on it for awhile and it became acceptable, and we really have been able to provide more streamlined care for patients," he said.

The program has cut the wait time for a consultation from nine months to just two to four weeks, with 90 per cent of surgeries being completed in less than six months, as opposed to two years.

'I'm seeing people who need to see me'

"It means that I'm seeing people who need to see me, instead of me trying to pay attention to someone who really doesn't need to see me, and I'm no longer dealing with the comment 'What? I waited two years for you to tell me this!' because they've already been in and seen someone who told them they were not an operative candidate",  said Puskas, pointing to another unique aspect of the clinic.

The program also brings together physiotherapists and doctors in a much more collaborative environment.

"We don't always trust each other's diagnoses, so we had to go through a period of time where we really got on the same page and used evidence from the literature to guide how we would deal with each different thing", he said. 

That new respect is also translating into better service for patients, said Puskas, explaining he was able to see 30 patients in the fracture clinic, while his advanced practice therapist colleague cared for another 14, with the understanding he was always available if his expertise was required.

Quicker access means less pain, fewer painkillers

"So basically she was able to put 50 per cent more patients through and have them have the confidence that they had the attention of the surgeon if they're needed."

Quicker access to specialists and a shorter wait for surgery is having a dramatic effect on people's quality of life, said Fanti, the program director.

"It reduces anxiety and stress. It's decreased lost time off work and it's also reduces the risk of narcotic dependence because you're not using pain pills to manage your pain and it also reduces unnecessary tests ordered that may not impact your plan of care."

Laurie Horlick, who was referred to the clinic in April 2018 and had her hip replaced in August, described her experience with the clinic as "amazing."

'I would do it again in a heartbeat'

"I talked to so many individuals and they were totally flabbergasted when I told them when my surgery was actually happening. They said 'are you serious? people wait two years!'" said Horlick.

"If I had to, I would do it in again in a heartbeat."

Fanti said they are planning to build on the success of their hip and knee replacement program and hope to soon include more back and spinal patients as well as people with shoulder, ankle and foot conditions.

As well, they also plan on making telehealth consultations available to people in their homes.

You can hear more about the Rapid Access Clinic from Dr. Dave Puskas and Laurie Horlick on CBC's Superior Morning here.