An Evaluation of the Primary-to-Specialist Referral System for Elective Hip and Knee Replacements in Alberta

Abstract

Introduction: Long waiting times for elective surgical procedures in the Canadian healthcare system are a concern for patients, physicians, and governments. Objective: To measure how changes in elective hip and knee arthroplasty referral processing for primary-to-specialist surgical consultations may impact accessibility, referral appropriateness, and efficiency. Methods: I documented current referral practices by conducting semi-structured interviews with clinical staff at three Alberta hip and knee musculoskeletal clinics, determined accessibility and referral appropriateness outcomes by reviewing 218 patient charts, and efficiency outcomes by conducting time studies at each clinic. Using scenario analyses, I estimated expected system-related improvements from implementing an electronic referral tool. Results: 20-54% of received referrals were incomplete or incorrectly directed, with involuntary waits accounting for 11-15% of waiting times. Implementing electronic referral could reduce inappropriate referrals, waiting time, and reduce staff time to process referrals by 20-25%. Conclusion: An electronic referral tool may reduce waiting times through streamlined referral practices.