The Saskatchewan Bariatric Surgical Program has been redesigned with exciting changes that will reduce wait times for patients in the province awaiting weight-loss surgery.
“We’ve combined our local expertise, learnings from the original program, all of our environmental scans, feedback from former and existing patients, and created this new program,” says Lilyans Zelada, manager of Surgical Pathways and lead of the improvement project for the Saskatchewan Health Authority.
Bariatric surgical program clients learning about the surgery and life-long maintenance required to be successful with their surgeries. Here, Vera Potter, RN, addresses the group. The group classes are held in Regina but many of the educational tools can now be found online, which reduces wait times to enrol.
The bariatric surgical program, located in Regina, was first launched as a pilot in 2008 and has continued to operate in a similar way for the last 10 years. The program assists patients who struggle with obesity to achieve and sustain their health. This is done by a multidisciplinary team who specializes in the care of bariatric patients. In order to participate in the program, patients must be referred by their attending physician or nurse practitioner.
While the program initially met the needs of the province, a growing waitlist of 1,300 patients has resulted in a significant wait for services. To improve wait times, clinic staff have redesigned the program to provide services in an innovative way, while maintaining patient experience as a top priority.
“We’ve involved patients throughout the development process to ensure the program is patient-focused. We asked former patients what their needs are and used this input, along with what we learned from other leading bariatric centres in Canada, to build this new program,” says Zelada.
Currently, bariatric surgeons are performing approximately 100 surgeries per year. With the improvements, it is anticipated the program will maximize the use of operating room time by having surgical patients who are better educated and better prepared. The new program is also meant to reduce wait times, helping patients receive services sooner.
The program is the only publicly-funded bariatric surgery program in Saskatchewan, serving patients from across the province.
“Geography is a major barrier for us,” notes Zelada. “We were challenged to think of how we could provide services without adding an increased burden of travel to patients. This is where the idea of online education, tools and resources came from.”
Before improvements were made, patients sat on the waitlist sometimes for longer than three years, receiving no services at all. Now, as soon as a patient is referred they are contacted by program staff, and their journey begins with online resources and learning.
Three online learning modules have been created and patients may work through them at their own pace. The modules introduce patients to concepts and basic tools they can use right away on their weight-loss journey.
“It’s important to have our patients making small, productive changes as soon as possible. Without early intervention, patients on the waiting list can deteriorate,” says Zelada. “These modules are amazing; our former patients have said they wished these were available when they started the program.”
After the online course, there is an open-house style orientation, which is another improvement. Zelada says patients find it helpful to learn as a group when possible, and engage the staff early with their questions — it’s at this point where patients usually make up their mind to advance into the program or not.
After the orientation at the Bariatric Clinic at 1621 Albert St. in Regina, patients participate in a Craving Change workshop, and throughout the next few months, become well acquainted with all members of the team.
The multi-disciplinary team consists of a dietician, psychologist, social worker, physiotherapist, registered nurse and a team of three surgeons.
Patients progress through the program by setting goals in each of the areas that require change. The team supports the patient until they are ready and approved by the surgeon to proceed to surgery. This usually takes six months, however others may take longer, each patient will have a slightly different experience that is unique to them.
A major commitment
Deciding to proceed with bariatric surgery is a significant decision and requires a life-long commitment to lifestyle and dietary changes. For example, after surgery patients must chew all of their food to a liquid consistency, and should not consume any carbonated beverages, even beer.
Upon learning of the life-long restrictions, many patients decide that surgery is not right for them and that’s OK, says Zelada.
“Some even do so well on their own with their weight loss, they decide they can keep going and don’t need surgery.”
One of the most important things Zelada and her team have learned is how important it is to educate patients about the surgery and the lifelong changes required as early as possible so patients know just exactly what they’re signing up for.
What is bariatric surgery?
Bariatric surgery reduces the size of the stomach, usually taking a stomach the size of a football and cutting most of it out, shrinking it to the size of a banana, or even a golf ball. Videos explaining more are available here.
There are two types of surgeries offered, the sleeve gastrectomy and the roux-en-y. Both surgeries will result in significant weight-loss if the strict dietary and lifestyle changes are followed.
This may sound like the easy solution for quick, significant weight loss, but Zelada and her team are careful not to glamourize it. They are constantly emphasizing that surgery is non-reversible and should be used as a tool only.
“You have to realize, you’re going to be the same person after surgery, just with a smaller stomach. You have to change all your past behaviours, look at the root cause of your unhealthy eating behaviours; we explore a lot of mental health issues during this process.”
Once the surgery has been performed, patients are not simply discharged. There are several check-ins to ensure they are maintaining their health. Patients are seen throughout the first year post-surgery to ensure they’re physically and emotionally well. The clinic provides supports, counseling and connections to the community in order for patients to continue progressing. After a year, patients are discharged to their family doctor for ongoing care.
This program is so much more than surgery and weight loss.
“Honestly, success isn’t just weight loss. Our patients are often able to stop taking many medications because they were related to weight issues. They regain their mobility and a better quality of life, finding they are able to participate in activities they hadn’t done in years. We encourage our patients to look for non-weight-related successes, such as putting on a pair of skates with their kids, riding a bike, or traveling with their family on an airplane. Those are huge successes.”