High-intensity interval theatre (HIIT) initiative to see Horizon complete up to 96 additional orthopaedic surgeries over next several months

All New Brunswickers deserve accessible and quality health care, and this initiative is one example of how Horizon is committed to providing that every day.

HORIZON – Members of Horizon Health Network (Horizon)’s Surgery Program are taking an innovative approach to performing surgeries on patients who have been waiting the longest for orthopaedic surgeries, which will improve access to surgical services and decrease the overall wait time for in-demand surgeries.

Surgical teams in Fredericton, Miramichi, Moncton and Saint John will complete a “blitz” of up to 96 surgeries – primarily orthopaedic (hip and knee replacements) – on Saturdays in November, December, January and February. Typically, operating rooms (ORs) do not run planned surgeries on weekends.

The goal of the initiative is to complete three to four arthroplasties in each of the four locations on a Saturday. This means, when the program is fully implemented, between 12 and 16 hip and knee replacements will be completed each Saturday and between 72 and 96 surgeries will be completed over the next several months.

“All New Brunswickers deserve accessible health care, and we are committed to providing that every day,” said Margaret Melanson, Horizon’s interim president and CEO. “This initiative is an innovative and efficient way to continue to address our systemic challenges and barriers to providing access to surgery.”

This initiative is known as “High-intensity interval theatre (HIIT)” lists. HIIT lists are recognized as an efficient way to complete “a month’s worth” of surgeries in a single day. HIIT lists are scheduled for Saturdays so as to not put pressure on a hospital’s regular schedules. 

The model was created by Guy’s and St Thomas’ NHS Foundation Trust, a health care organization in the United Kingdom. Their initiative (high intensity theatre, or HIT, lists) was inspired by Formula 1 motor-racing pitstop techniques — achieving maximum efficiency and safety by boosting surgeons’ operating time and eliminating all possible patient delays on the day.

This initiative involves intensive planning and preparation from a multidisciplinary team of health care professionals, including anesthetists, surgeons and registered nurses (RNs), licensed practical nurses (LPNs) in OR, day surgery, Post Anesthesia Care Unit (PACU) and inpatient units, as well as patient care attendants (PCAs), respiratory therapists, environmental services, medical device reprocessing (MDR), medical imaging, laboratory, pharmacy, physiotherapy and occupational therapy staff.

“I am extremely appreciative of the health care workers who are taking time from their weekends to provide this exceptional care for their patients,” said Melanson. “They have gone above and beyond to make this initiative possible.”

This also involves several pre-operative meetings with patients, to ensure the best candidates are selected. Patients waiting the longest will be the first group considered for this initiative.

The HIIT initiative will start Saturday, Nov. 26 at Horizon’s The Moncton Hospital (TMH), and other hospitals will begin in the following weeks. The initiative will continue on Saturdays through December, January and February.

Background information

The national benchmark for wait times for both hip and knee replacements is 182 days.

Across Horizon, five of out 10 hip replacements are completed in an average of 313 days and nine of out 10 are completed within 524 days.

Across Horizon, five of out 10 knee replacements are completed in 391 days and nine of out 10 are completed within 590 days.

There are currently more than 2,000 people waiting for a hip or knee replacement within Horizon. 

On average, over the last five years, Horizon performed about almost 1,700 (combined) hip and knee replacements in one year. (This number includes only elective and primary cases; this does not include urgent and revision cases.)

The following hospitals offer hip and knee replacements: Dr. Everett Chalmers Regional Hospital in Fredericton; The Moncton Hospital; Miramichi Regional Hospital; Saint John Regional Hospital; and St. Joseph’s Hospital (as of October 2020).

Improving access to health care, specifically emergency care, surgical services and addiction and mental health services, is a key priority of Horizon’s plan to ensure all New Brunswickers receive the quality care they need. This plan consists of three other priorities, including the retention and recruitment of physicians, nurses and staff; improving overall patient experience; and improving patient flow at our health care facilities. Further details about Horizon’s four priority areas are available at HorizonNB.ca.

This initiative also supports the Government of New Brunswick’s provincial health plan, Stabilizing Health Care: An Urgent Call to Action, specifically, the action area of creating improved access to surgery.

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