Improving surgical access: the Vancouver experience.

The University of British Columbia Hospital program was designed to augment existing provincial capacity for hip and knee replacement. The patient-surgeon relationship was maintained throughout the entire care pathway and "ring-fenced" capacity (i.e., designated hospital ward bed and operating room capacity that is geographically remote from the emergency intake of patients) minimized the risk of cancellations. Analysis of the results revealed a mean patient satisfaction score of 4.7 out of 5, a complication rate of 4.4%, a mean operating room time of 1 hour and 45 minutes and a mean postoperative length of stay in hospital of 3.4 days. More than 1600 joint replacements -- an additional 16% provincial capacity -- were performed within budget during each of the first 2 years of operation. A high standard of care was maintained, with high rates of patient satisfaction and a low complication rate.