title: New design of care: Assessment of an interdisciplinary orthopaedic clinic with a pivot nurse in the province of Quebec.
abstract: BACKGROUND
  New designs of care in orthopaedic clinics are needed to cope with the shortage of orthopaedic surgeons and the lengthening of waiting times.
  
  
  OBJECTIVE
  To assess the effectiveness of an interdisciplinary orthopaedic clinic with a pivot nurse in the Canadian province of Quebec with regard to accessibility, quality of care, efficacy and efficiency of the clinic, and patient's quality of life.
  
  
  METHODS
  Two strategies were developed: (1) a selected cohort of new patients attending an orthopaedic service from February to September 2008 were entered into a database recording patient details, source of referral, diagnosis, satisfaction, and quality of life (36-Item Short Form Health Survey version 2). In this setting, 2 sets of questionnaires were administered to the patients: the first one during the first visit and the second one, 2 months later. A total of 243 patients from the case control were compared with 89 patients of the case study, where an interdisciplinary orthopaedic clinic with a pivot nurse has been developed; (2) costs per patient were calculated using the staff timesheets provided by the two orthopaedic clinics.
  
  
  RESULTS
  The results showed a significant reduction in the waiting-list duration (accessibility) in the case study clinic owing to a strong decrease in the inappropriate consultations with the orthopaedic consultant. The quality of care remained high, and the target surgeries for total hip and knee replacement were reached, despite a strong shortage of orthopaedic doctors.
  
  
  CONCLUSIONS
  Interdisciplinary orthopaedic clinic with a pivot nurse is a new approach in the province of Quebec and first results are encouraging.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Poder
authors.forename: Christian
authors.initials: C
authors.lastname: Bellemare
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Bédard
authors.forename: Jie
authors.initials: J
authors.lastname: He
authors.forename: Renald
authors.initials: R
authors.lastname: Lemieux
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration* / Q000592:standards; D003266:Continuity of Patient Care; D016530:Orthopedic Nursing; D010347:Patient Care Planning; D011792:Quebec; D000078329:Workforce