The orthopedic case manager: a facilitator's role

Last October, Mr. Kevin Murphy was hospitalized for almost a month following a serious motorcycle collision that left him with multiple fractures in his lower limbs. His stay at the Montreal General Hospital (MGH) was punctuated by numerous surgeries, and despite being discharged for the first time, he was readmitted a second time for additional surgery. Thanks to a patient-centered quality care pilot project, Kevin benefited from the dedicated support of Nikolai Iartsev, an orthopedic case manager. Nikolai played a key role in coordinating Kevin's care, ensuring a smoother journey during his hospital stay.


Patient Kevin Murphy and Nikolai Lartsev, orthopaedic case manager at the MGH, MUHC

Patient Kevin Murphy and Nikolai Iartsev, orthopaedic case manager at the MGH, MUHC


Complex case, complex care

Mr. Murphy's wound was complex, and therefore complicated the care he needed to receive. Because of the fixed rods attached to his leg to stabilize his fracture, this increased the difficulty of performing a particular wound care therapy called VAC-dressing, a method that reduces air pressure around the wound along with any fluids that drain from the wound to facilitate healing. Kevin admits to expressing a great deal of frustration at this point, but Nikolai stepped in and was there to help manage the situation. He took the time to discuss his patient's concerns and find solutions in collaboration with the care teams, thus avoiding any delay in the care he required.

« The help I received from the nurses and the medical team here at the Montreal General Hospital was incredible… And Niki (Nikolai) helped me tremendously, » says Mr. Murphy.



“Montreal General Hospital is a world class traumatology center and it is a privilege to contribute to the incredible work done by its staff. To see patients succeed and improve to the point of regaining their independence is immensely fulfilling as a clinician and reaffirms my passion for the domain,” says Nikolai.


A successful pilot project

The orthopedic case manager has a global view of the care plan and trajectory of orthopedic patients.

“He acts as a facilitator, coordinating activities and communications between medical teams, always with a patient-focused orientation. This role optimizes the quality of care and avoids delays, with a view to reducing hospital stays and increasing patient satisfaction,” explains Paule Jubinville, Nurse Manager, Orthopedic Surgery, Trauma and Traumatic Brain Injury at the MGH.

This is a pilot project, collaboratively lead by nursing and Dr. Gregory Berry, Chief Division of Orthopeadic surgery, is funded by the Montreal General Hospital Foundation, which began in autumn 2022. The project was presented at the Canadian Orthopedic Nurse Association's national conference, held in Halifax on June 12.