GTA Rehab Network Referral Practices
The GTA Rehab Network has released a standardized Outpatient Rehabilitation Model of Care Following Primary Elective Total Joint Replacement (TJR). The model was developed to ensure patients experience a smooth transition from acute care to outpatient rehabilitation in the GTA following primary elective total joint replacement and to support the provincial target to discharge 90 per cent of acute care patients to home, as originally set by the Orthopaedic Expert Panel and as set out in the Quality-Based Procedures: Clinical Handbook for Primary Hip and Knee Replacement (Health Quality Ontario; Ministry of Health and Long-Term Care, November 2013).
This model of care clarifies and standardizes the processes involved in arranging post-acute rehabilitation across the GTA, and includes a model of outpatient rehabilitation for this patient population. The complete, updated Outpatient Rehabilitation Model of Care Following Primary Elective Total Joint Replacement includes:
- Separate care pathways for outpatient rehabilitation post primary knee and primary hip replacement
- Processes in the pre-operative, acute care admission and outpatient rehabilitation phases, and responsibilities for acute care and rehabilitation to support the smooth transition of patients to outpatient rehabilitation
- Pre-operative triage considerations for referral to outpatient/inpatient rehabilitation
- Criteria for referral to Community Care Access Centres (homecare agencies)
- A single page referral form for the pre-op and post-op phase with a listing of GTA Rehab Network member hospitals within the GTA that accept external referrals to outpatient rehabilitation for this population
- Key messages for patients to help prepare them for surgery and discharge to home
- TJR Follow Up Form
- GTA funded transportation options.
The model can be found at http://www.gtarehabnetwork.ca/total-joint-replacements