Sent on behalf of Dr. van der Vyver, Martin - June 5, 2024
Starting July 1st, one list/week will be used as a 'triage room' for semi-urgent cases. See the policy below.
Note:
If admitted to Bayview (ward or ER) - the ortho team will request an anes consult to determine if they are candidates for surgery at the Holland Centre. Please see the Holland Centre exclusion criteria. If you are the staff reviewing consults and are unsure if the patient is a candidate, don't hesitate to contact me directly.
If they are admitted elsewhere, the anesthesia coordinator at Holland Centre will be the point of contact. They will be asked to review the available information on Connecting Ontario. After hours, the hospitalist on call will be the point of contact.
Note: The orthopedic team is aware that accepting the transfer does not guarantee they are eligible for surgery at the Holland Centre.
We are already doing these cases at the Holland Centre, and while the volumes may go up above is an attempt to standardize the process.
Policy For Holland Centre Arthroplasty Triage Room
Starting in July of 2024, one Holland Centre TJR room each week will be allocated to “urgent” arthroplasty cases. The plan from the arthroplasty group is to use one TJR day per week for more urgent arthroplasty cases. The surgeon assigned to this OR time will change each week; each arthroplasty surgeon operating at the HOAC (of which there are eight) will get equal access on a rotating basis. The date of this urgent arthroplasty room will change each week so that the assigned surgeon can schedule it into their current weekly workload.
The booking plan is as follows:
Cases booked into this OR time will only be those that meet HOAC admission criteria (see “Exclusion Criteria for Surgery at the HOAC”). These cases will involve urgent cases identified in the HOAC or Bayview clinic, in the Sunnybrook Bayview campus emergency room (ER), or from the community that require urgent surgery (such as an infected total joint, an unstable hip, a periprosthetic fracture, or a primary or revision arthroplasty).
If such a patient is seen in the Bayview ER, the orthopedic surgeon consulting on the patient will get input from the Bayview anesthesia team on whether the patient can have surgery at the HOAC campus (as per the process currently in practice).
If the patient is from an outside hospital, the Sunnybrook surgeon consulting on the patient will contact the HOAC medicine and anesthesia teams about whether the patient should be transferred to the HOAC or Bayview campus (as per the process currently in practice).
On weekdays, they should contact the Holland Centre anesthesia coordinator.
On weekends, the surgeon should contact the Holland Centre hospitalist on call, who will then determine if input from anesthesia is necessary.
All patients that have the surgery performed the HOAC will stay in-hospital in the early postoperative phase and will be transferred back to the referring hospital once cleared for transfer (as per the process that is currently in practice).
To ensure appropriate use of this OR time for patients with urgent conditions, cases can be booked into this time as close to the operating room date as is logistically possible.
If no urgent cases are identified for that OR time, the surgeon assigned to that OR time will use it for TJR cases from her or his wait list. It is recommended that the surgeon pre-emptively book patients into this operating room far in advance so that if no urgent cases are identified for that OR block, the operating room time will be filled. These patients should be notified that their surgery may be canceled and moved into the near future to accommodate urgent cases.
The intention of this urgent OR is to help minimize the number of cases done at the Bayview campus that could have been done at the HOAC, thus taking pressures off Bayview inpatient beds.
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