Failing figures for hip and knee replacements

The Canadian Institute for Health Information released its latest annual wait-times report. Supposedly Nova Scotia has improved over the last five years on wait times for five priority procedures: hip replacement, knee replacement, hip fracture repair, cataract surgery and radiation therapy.

http://www.cbc.ca/news/canada/nova-scotia/hip-knee-replacement-wait-times-1.4044037

It’s a curious report. The numbers are for a five-year period from 2012 and 2016. If you check out the CIHI website for hip fracture repair, cataract surgery and radiation therapy the response is “no data available”. So how do we know those wait times have improved?

http://waittimes.cihi.ca/NS?region=Nova-Scotia-Health-Authority-Zone-1-Western#year

http://waittimes.cihi.ca/NS?region=Nova-Scotia-Health-Authority-Zone-2-Northern#year

http://waittimes.cihi.ca/NS?region=Nova-Scotia-Health-Authority-Zone-3-Eastern#year

http://waittimes.cihi.ca/NS?region=Nova-Scotia-Health-Authority-Zone-4-Central

As for hip and knee replacement, this is a story of cause-and-effect. The CIHI says the Nova Scotia Health Authority’s (NSHA) Zone 4, the Central Zone, is doing well. Results are poorer in Zones 2 and 3, with the worst in Zone 1.

Zone 1 is the South Shore, Yarmouth and Valley. In 2012 the Annapolis Valley District Health Authority (AVDHA), which was overseen by CEO Janet Knox and VP Medicine Dr. Lynne Harrigan, lost the services of Dr. Veljkovic, who was an orthopedic surgeon specializing in foot and leg surgeries related to diabetes. Dr. Veljkovic travelled this area, seeing patients in Kentville, Middleton, Yarmouth, Shelburne and Bridgewater. She left to practice in Ontario because AVDHA didn’t request funds to pay for her services! There is a quota which says AVDHA should have five orthopedic surgeons. Dr. Veljkovic was the 6th, so the health executives took to a strict bureaucratic stance to pay for five surgeons not six. Obviously, the need for such services is greater than the surgical quota suggests.

In Pictou, which is in the underperforming Zone 2, they also lost an orthopedic surgeon because the pre-merger health authority wouldn’t provide sufficient operating room access. It was a budget-stretching move. That surgeon moved to Florida with his wife who happened to be a family physician.

According to the Auditor General’s 2014 report, which relied on CIHI information, Nova Scotia only met national benchmarks for hip replacement 58 percent of the time. That’s a 42 percent failure rate. For knee replacement the failure rate was 57 percent.

Using the just released CIHI figures, Nova Scotia’s average success rate for meeting national hip replacement benchmarks is 56.75 percent. That’s a 43.25 percent failure rate. In 2014 only 43 percent of knee replacements were done to the benchmark. The current figures show this has slipped to 40 percent. Nova Scotia might be doing better than 2012, but we’ve slipped from 2014.

This is disappointing and confusing. Since the province-wide collaboration of facilities from the merger of health authorities, patients have been given the option of travelling to places like Amherst to have their knee replacement done faster than waiting for a surgical time closer to home.

We’ve assembled the provincial resources to give patients choice, the government has put additional money into orthopedic surgeries and we’re still lipping along when it comes to providing the level of health care Nova Scotians deserve. It proves what researchers, consultants and studies have been saying: money isn’t the only issue when it comes to delivering better care. The problem has to be management.

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