Drs. Sarah Ward and Jesse Wolfstadt in Toronto Star: “Reducing unnecessary testing may improve access to care”

As orthopedic surgeons and pathologists, we see an opportunity for improvement that can help free up time and limited resources.

By Sarah Ward
Jesse Wolfstadt
Corwyn Rowsell

Thu., Aug. 25, 2022

The COVID-19 pandemic has amplified inefficiencies and lack of access to resources that have stressed Ontario’s health care system to the brink. Many Canadians have seen or heard about potential ICU closures, shuttering of emergency rooms and cancelled elective surgeries.

There is growing concern from both providers and patients about the backlog of postponed surgeries, especially as hospitals struggle with daily operations due to enormous staffing challenges.

In Ontario, a large part of the backlog in surgeries consists of patients awaiting hip and knee replacement operations. Ontario performs almost 50,000 hip and knee replacements each year, and the demand for these surgeries continues to rise.

With hospitals understaffed and overloaded with patients who are anxiously awaiting long-delayed surgeries, now is the time to ensure that all our processes are as efficient as possible.

As orthopedic surgeons and pathologists, we see an opportunity for improvement that can help free up time and limited resources.

But several studies show routine pathology testing does not help or change patient care for those undergoing hip and knee surgeries.

In fact, in other provinces, there are major efforts underway to reduce this practice. Manitoba reduced pathology testing for hip and knee surgeries by 93 per cent without negatively impacting patient care.

In Ontario, this routine practice remains entrenched due to many hospitals legal department’s interpretation of regulation 965 of the Public Hospitals Act, which mandates that such tissues removed during an operation be sent together with a short history of the case to a laboratory for examination and report.

Pathology testing requires time and effort from staff, including technologists, pathologists’ assistants and pathologists, as well as the use of hazardous chemicals and storage space. It also diverts finite resources from patients who need timely diagnosis, such as those undergoing cancer treatment.

Many groups, including Choosing Wisely Canada, in collaboration with the Canadian orthopedic Association and the Canadian Arthroplasty Society, have recommended against the routine use of pathological examination for these surgeries. In fact, in July 2019, Choosing Wisely Canada and the Ontario Orthopedic Association sent a joint letter to the Ontario government requesting a simple amendment to the act to remove the requirement for hip and knee tissues to be sent to the pathology lab for routine testing.

Unfortunately, as it currently stands, hospitals that choose to practice according to scientific evidence would be breaking the law. We are seeing firsthand the cracks in our system unfold that have forced hospitals into crisis mode. Now is the time to find improvements and end redundant practices so Canadians can have timely access to the care they need.

Dr. Sarah Ward is an orthopedic surgeon at St. Michael’s Hospital. Dr. Jesse Wolfstadt is an orthopedic surgeon at Mount Sinai Hospital. Dr. Corwyn Rowsell is a staff pathologist at St. Michael’s Hospital.

Source: The Toronto Star