Patient Tori Orosz has her knee examined using a Goniometer on Wednesday, Dec. 7, 2011.Chris Bolin
For the hundreds of thousands of Canadians who will injure a knee this year, getting the right treatment at the right time can become the biggest challenge. But a unique clinic in Calgary is offering a new way to give patients what they need, while at the same time lowering costs and alleviating pressure on the country's limited number of orthopedic surgeons.
An interim report being released on Thursday shows that since it opened in January, the University of Calgary Sport Medicine Centre's acute knee injury clinic has enabled 966 patients to get direct access to elite-level care, and reduced wait times and unnecessary tests.
"If you hurt your knee, one of the most important things you can receive is timely, accurate assessment and care, and unfortunately, that doesn't always happen in today's health-care system," said AKIC's founder, Nick Mohtadi, an orthopedic surgeon and former head physician for the NHL's Calgary Flames.
To access the clinic, which received $255,000 from Alberta Health Services for a 12-month trial, a patient simply fills out an online questionnaire, available at www.sportmed.ucalgary.ca/akic, as soon as they are injured instead of going to a hospital emergency. If the injury is considered acute, which AKIC defines as the result of a trauma that has occurred within the past six weeks, the patient gets an immediate appointment (the average wait has been 8.7 days, but the target is three business days).
The initial evaluation is done by one of three "non-physician experts," which is the clinic's name for the trained, certified athletic therapists who work directly with onsite sport medicine physicians.
"As it turns out, the majority of the patients we've treated had non-surgical problems that were addressed directly by our staff," said the centre's director, Preston Wiley. The 208 patients who required an orthopedic surgeon were operated on within four months of diagnosis, five months earlier than patients outside of the clinic. "In just about everything we measured, we were able to see improvements," said Dr. Mohtadi.
The non-physician experts have been trained to evaluate quickly whether further diagnostic testing is needed before determining the appropriate treatment, which has lead to a reduction in the need for MRIs since the program began to 7.5 per cent from 30 per cent in AKIC's patients.
"People are under the misguided impression that an MRI is needed to get an operation and that's simply not the case," said Dr. Mohtadi, who adds that about 60 per cent of individuals with acute knee injuries can fully recover without surgery.
According to Tracy Wasylak, vice-president and co-lead of the Bone and Joint Clinical Network, which is overseeing the project on behalf of AHS, one of the goals is to reduce demands on emergency departments and free up resources for patients with more serious orthopedic injuries and illnesses. "This clinic has the ability to provide timely diagnosis and treatment for up to 200 patients a month." (All services are fully funded by Alberta Health Care.)
But AKIC's approach is so unusual that few Albertans know it exists – to date, it's only being used by an average of 95 patients a month.
"We are one of the few health-care services that still has lots of capacity," Dr. Mohtadi said. "We know the patients are out there and we need different strategies for getting them in, because the person who is injured tomorrow doesn't hear the message today."
The clinic's future will depend upon whether it can show that it's not just good for patients but also for the bottom line.
"So far, I'd have to say the clinic has been very successful, and it's certainly doing what we thought it would," said Dr. Mohtadi, who began developing the model 12 years ago and sees it being applied effectively to other types of musculoskeletal injuries. "There's no question that it lends itself to the acutely injured individual. Whether it can be applied to chronic problems has yet to be seen and that's probably a larger area of concern for the health-care system."