The North Simcoe Muskoka Local Health Integration Network (NSM LHIN) is a health care region in Ontario that includes the following acute care hospitals: Royal Victoria Regional Hospital (RVH), Collingwood General and Marine Hospital (CGMH), Orillia Soldiers Memorial Hospital (OSMH), Georgian Bay General Hospital (GBGH) and Muskoka Algonquin Healthcare (MAHC), All hospitals in the NSM LHIN receive orthopaedic cases through their emergency departments and all provide emergency care. Historically two of the five acute hospitals, RVH and CGMH, have had a full orthopaedic surgery program with OSMH hosting a small program for elective patients only. With the limited resources and the lack of coordination of orthopaedic care, access to care for patients, specifically hip fracture patients, has long been a challenge in the North Simcoe Muskoka area. The provincial benchmark of surgery within 48 hours of fracture has not been consistently met and emergency room staff were frustrated with the inability to access appropriate care for their patients. In 2012 therefore work was undertaken to develop a regional approach to orthopaedics.

The proposal saw the expansion of OSMH to accommodate electives and trauma through the addition of two orthopaedic surgeons. With these additional services an Integration Proposal was developed in 2013 to improve services and all hospitals and the NSM Community Care Access Center signed onto the future vision. The first part of the plan was to facilitate access to surgery for hip fracture patients. This project was launched in April 2014 and has seen a coordinated approach to the assignment of surgical services across the continuum of care between the hospitals. The Integration Proposal also supports the effective management of rehabilitation services and work is being undertaken to define and implement evidence based rehabilitation services for hip fracture and hip and knee replacement patients.