The single-entry model (SEM) in healthcare consolidates waiting lists through a single
point-of-entry and patients can see the next available surgeon from a pooled available provider
based on the patient’s urgent levels. Prioritization is used to ensure that patients with higher
urgent levels may access care quickly. The SEM for hip and knee replacement surgery in the
Eastern Health region of Newfoundland and Labrador showed a reduction in wait times for
consultation by priority levels. Little is known about the improvement in wait times for surgery
and the chance of receiving consultation and surgery within the national benchmarks by priority
levels. This study aimed to examine the SEM’s role in timely access to orthopedic services and
evaluate an association between factors and receiving consultation and surgery within the
national benchmarks through the SEM.
Survival analysis was conducted to estimate wait times, examine factors impacting wait
times for hip and knee replacement. The data used were adult patients referred to the Orthopedic
Central Intake clinic in the Eastern Health region for a total hip or knee arthroplasty assessment
between 2011-2019. Logistic regression analysis was used to explore the association between
these factors and the receiving consultation and surgery within benchmarks.
The study revealed that hip or knee replacement patients with high urgent had more likely
to see an orthopedic surgeon for consultation than those with low urgent. Hip or knee
replacement patients with priority 1 were more likely to have a consultation within 90 days than
their counterparts. Priority levels were not significantly related to the likelihood of having
surgery since the decision to surgery was made for both hip and knee. The likelihood of receiving
a knee replacement surgery within 182 days was nonsignificant among patients with priority 1, priority 2, and priority 3, while hip replacement patients with priority 3 were more likely to have
surgery within 182 days than those with a high priority level.
Choosing the next available surgeon shortened wait times for consultation and improved
the likelihood of receiving consultation within 90 days. However, this choice was less likely to
have surgery within 182 days than choosing a specific surgeon. Incomplete initial referral forms
prolonged wait times for consultation but insignificantly impacted the probability of having
consultation within 90 days. Patients with knee osteoarthritis were less likely to have
consultations within 90 days than patients with other arthritis disorders.
This study explored the timely improvement of access to consultation for hip and knee
replacement by priority levels and factors impacting wait times through the SEM. An association
between wait time for surgery and priority levels was not found in this study, whereas hip
replacement patients with low priority were more likely to receive surgery within the benchmark
of 182 days than those with high priority. Further studies are needed to investigate this
