MGH improves orthopaedic care with new initiative: Rapid Access Clinic

By: Louise Allyn Palma

Caroline Morrison struggled with an injury in her left knee 19 years ago and had an arthroscopy done to ease that pain. The injections managed to alleviate the pain – until, she realized recently that she was having trouble with daily activities, including walking and descending stairs.

She consulted her family doctor. “Although the injections helped - I walk a lot, so that had finally caught up with me,” she said.

Caroline was referred to the Rapid Access Clinic (RAC) in Michael Garron Hospital’s (MGH) Fracture Clinic. She met Sherri Stevenson, the Advanced Practice Physiotherapist (APP) lead for the RAC and the only APP at MGH.

“The Rapid Access Clinic is designed to get people through an assessment and to a surgeon faster if they need a total hip or total knee replacement,” explains Sherri.

“At the end of their 45 minute assessment, we decide if the patient is best served by seeing a surgeon about a joint replacement or if they are better off using conservative strategies like physiotherapy or exercise or other things that we can do.”

As a ministry mandated program, the RAC facilitates the needs of orthopaedic patients and decreases the time associated with them waiting for surgery.

"The goal of the RAC is to decrease wait times for the initial consult with the surgeon. The APP performs an in-depth assessment enabling the physician to make timely decisions about whether surgery is required or not,” Says Nancy Elford, manager, Rapid Access Clinic.

If patients need surgery, the APP, Sherri, refers the patient on to the surgeon with a summary of the assessment findings. The process to surgery or finding a preferred solution is sped up with the APP taking on this crucial role.

“I was very impressed. She was easy to relate to. She did a history, physical exam, questionnaires, reviewed copies of my x-rays and confirmed that both my joints were suitable for replacement,” says Caroline.

“I myself was a physio orthopedist and everything had happened much more quickly than I had anticipated, as it was very well-organized.”  

Caroline was set for a knee replacement surgery in July. But before her next meeting with her surgeon, she felt an unbearable pain in her knee and was advised that her surgery should happen “sooner rather than later,” she says. Her surgery is set for later this month.

Sherri normally sees patients six weeks post-operation as well, following up with the same patients.

“It’s definitely a strength of the physiotherapy role to have time with the patient. Our rapport is built as you learn their detailed history from the beginning,” says Sherri. “It’s not just about the fact that their knee(or hip) hurts, but they tell you about how it’s impacting their life. We ask detailed questions about functional status, and I think people really appreciate being heard.”

The Rapid Access Clinic launched on April 1 and Nancy feels that it is already on a positive path, with excellent feedback from patients.

Not only are wait times being reduced, but she feels that with Sherri’s active role with the RAC, patients are being heard.

“They have a voice. Somebody is listening to them and meeting their needs,” says Nancy. “There is a person who will call them back in a reasonable amount of time frame and someone who will listen to them and help them navigate the system.”