GPs and Orthos ROCC 'n Roll

"To be able to drive change together is really exciting", says North Shore family physician, Dr Lisa Gaede.

Dr Gaede is describing her involvement in a Shared Care project that brought together North Shore GPs and orthopaedic specialists to address a common goal — to reduce wait times and increase access to orthopaedic specialist care for local patients, not just on the North Shore, but throughout the Coastal Region.  With the introduction of a Rapid Orthopaedic Consult Clinic (ROCC) and a new referral system,  96% of patients are now rating their satisfaction with the system and access to consultations as eight or higher, with 68% giving it a 10.

How did it work

Led by a working group co-chaired by Dr Gaede and orthopaedic specialist, Dr Alan Baggoo, the project started in Aug 2012 after family physicians and specialists identified misdirected referrals and lack of communication as contributing to extensive wait times - patients were waiting an average of 18-24 months to see an orthopedic specialist. The groups decided to work together to improve this.

Looking at the current wait list, the project team started working on developing solutions for an improved system. After 18 months, and the successful engagement of nine orthopedic surgeons and approximately 160 family physicians, all patients on the list had been triaged and appropriately referred. Solutions included:

• Enhanced screening to ensure patients are seen by the right provider at the outset.
• A centralized referral system to avoid misdirected referrals, unnecessary imaging, and provide access to the first available specialist.
• A system to acknowledge receipt of referrals, inform the patient and GP of expected wait times for consultations, and clarify next steps and request additional information if required.
• An orthopedic phone line for quick access for GPs to specialist advice

Results & Benefits

The new processes resulted in a dramatic reduction in wait times to see an orthopaedic specialist - decreasing from 18 - 24 months, to the current time of just three months. A patient who benefited from the new referral system expressed her surprise with the speed of her care "I had heard from others about how slow the whole process was for specialist referrals, so I was very impressed with how quickly I got an appointment with Dr McConkey. The whole process from referral to surgery only took 12 weeks."

Family physicians have also been enthusiastic about the improved communication with their orthopaedic colleagues, and specialists have stated they appreciate the more efficient use of their orthopaedic consultation time.

Sharing Success

The North Shore group has been sharing successes and challenges of the project with New Westminster Orthopods and GPs, to help spread the model to the Fraser Northwest region. 

Next Steps

Currently the North Shore physicians are focusing on the challenge of allocating the necessary resources to sustain their system improvements, and to integrate services with other care providers.

For more information, please contact Initiative Lead, Bethina Abrahams at babrahams@doctorsofbc.ca