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- Page navigation anchor for RE: Reporting and evaluating wait times for urgent hip fracture surgery in Ontario, CanadaRE: Reporting and evaluating wait times for urgent hip fracture surgery in Ontario, Canada
I would like to praise the authors on this article, and commend them on their ongoing work. As a community based Orthopaedic Surgeon who works in a medium sized hospital which services rural to very-rural areas, I believe there is an area identified in the article that merits further review in the scope of rural practice - the fact that hospital level delays seem to be the at root of much variation in wait times.
The authors address the fact that hip fracture care needs to be streamlined and have clear algorithms, such as the one developed in Manitoba. This initiative focused on expediting transfers, cutting down on unnecessary pre-operative tests and steps, increasing the availability of OR time for hip fractures, and collaboration with referral centres to repatriate patients post-operatively. While this model is efficacious and is likely to be embraced by surgeons and patients alike, without strong administrative support, it remains an unachievable aspiration.
Our current benchmark is set at 48 hours from time of admission to time of surgery, but this is likely and justifiably going to be shortened to 24 hours, and perhaps even less. The most recent CMAJ paper from Sobolev et al. leans this way in suggesting that hip fractures should be done on the day of admission, or the day thereafter. The fallout of the same for medium and small sized community hospitals is likely to be tremendous.
The article by Sheehan et al. (In-hospital mortality after hi...
Show MoreCompeting Interests: None declared. - Page navigation anchor for RE: Reporting and evaluating wait times for urgent hip fracture surgery in OntarioRE: Reporting and evaluating wait times for urgent hip fracture surgery in Ontario
As a surgeon in Ontario, it does not come as a surprise that patients are not getting surgeries in a timely manner. I have watched over the last few years, an incredible drop in availability of OR times, both for elective and emergency surgery in our province.
I frequently have to "Bump" colleagues or have my cases bumped, due to higher priorities cases. Historically, Hip fractures are seen as C cases, which means there is a window of 48 hours to get them done.
The problem is further aggravated by the fact that most hospital operating rooms only start the " emergency lists after all the elective surgeries for the day are done, which is usually not before 3:30pm, but more often than not, not until 5pm. And C cases aren't done after 11pm, which means that these cases have a window of seven and half hours to get done, or they are postponed to the next day, after 3:30pm.That is also a dehumanization of the care, and cases in the operating room lists are seen as a " hip fracture" or an "ischemic leg". There is never the case of Mr. Smith, who is the father of 3 who has been waiting for 2 days for his surgery and will miss his granddaughter's wedding.
It is very concerning that hospital administration and the Ministry of Health and Long Term Care have put the focus on saving money as much as possible, in detriment to patient care. Not surprisingly, the results are poorer outcomes and increased costs to th...
Show MoreCompeting Interests: None declared.