For individuals who are experiencing severe symptoms of hip and knee osteoarthritis a surgical consultation with an orthopaedic surgeon is often recommended to discuss the option of joint replacement surgery.
During this surgery the affected bones are removed and replaced with metal or plastic components. For many patients this surgery provides relief of symptoms and can lead to an increase in their functional abilities. However there are many factors that need to be taken into consideration when making a decision on whether this surgery is the right choice for each individual patient. This decision is made by the patient in consultation with the surgeon however there are many system factors that need to be taken into consideration to ensure that the patient and the surgeon have the right amount of information as well as the right amount of time to make an informed decision.
BJC hosted a meeting, which was attended by surgeons, researchers, clinicians, including nurses and physiotherapists, as well as individuals who coordinate the health care system to review the system factors that need to be in place for effective decision-making. A summary of the factors are:
- Standardized process throughout surgery and recovery built on best clinical practices
- Patient education to address their expectations from the surgery
- Effective and respectful patient decision process including time to discuss with family
- Evidence of failed conservative management in an evidence based program
- Effective intake process
- Timely access and active management of resources
- Standardized loop back to primary care
- Data system that effectively promotes decision making
- Funding aligns with program and incents the system to performance
Further work will be undertaken to develop recommendations on the design of a healthcare system to ensure the right patients are getting to surgery at the right time.