St. Michael’s Mobility Clinic implements standardized tracking of patient reported outcomes following hip and knee surgeries
Toronto, February 3, 2021
By Maria Sarrouh
Photo of a hip replacement surgery completed at St. Michael's Hospital in 2018. (Photo by Yuri Markarov)
Two years ago, the Ontario Ministry of Long-Term Care began testing the implementation of Patient Reported Outcome Measures associated with hip and knee replacement surgeries in hospital setting across the province in 2018. The Mobility Clinic at St. Michael’s served as a pilot site for the project.
Now, staff say they are beginning to see their efforts validated as patients return to the clinic with improved scores following surgery.
Angelo Papachristos, an Advanced Practice Physiotherapist in the Mobility Clinic, explained the Patient Reported Outcome Measures (PROMs) help clinicians understand their patient’s baseline level of disability and track their improvement post-surgery over the course of a year.
“You can track how much pain they were in before surgery, and how much pain they’re in after. That’s data we really didn’t have before,” he said. “That data can help us make improvements in the quality of our care.”
The implementation of the protocol for the collection of the PROMs was challenging at first, according to Nancy Freitas, Clerical Assistant in St. Michael’s Mobility Clinic. The program started on paper, with clericals and physiotherapists inputting and calculating the PROMs themselves.
Six months later the program moved online, successfully overcoming several technical difficulties in the process. It required changing standard clinical practices and the involvement of a multidisciplinary team, including clinical coordinators, senior management, infection control, tech support and clinical staff like orthopedic surgeons and physiotherapists.
“Now, with every single referral that comes in related to hips or knees, we automatically add the patient into the PROMs system. It’s part of our routine,” Freitas said.
Dr. Sarah Ward, an orthopedic surgeon at St. Michael’s, called the clericals and physiotherapists working in the mobility clinic the “unsung heroes” in getting the process off the ground.
When orthopedic surgeons are prescribing pain medication post-operatively, making adjustments to the physiotherapy regimen of patients or implementing new surgical techniques, they will now be able to check to see if those changes are reflected in better PROMs scores, helping to validate that process changes are resulting in improvement.
Surgeons can look at an X-ray, check if an incision has healed or if a knee moves properly, but the PROMs are more telling of how a patient is really feeling, Dr. Ward explained. She said it’s good to see staff’s commitment to making improvements and using evidence-based practice.
“We can see that our patients are in fact doing as well as we think they are,” Dr. Ward said. “That’s why we do what we do, to make patients feel better in their day to day lives.”
About St. Michael's Hospital
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.
About Unity Health Toronto
Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.