When patients are referred to the Rapid Access to Cardiology Evaluation (RACE) Clinic, timely assessment is essential. However, at Penticton Regional Hospital (PRH), patients were waiting too long to be seen, with some referrals delayed by requirements for multiple pre-tests before a consultation could even be booked. 

Recognizing that the clinic was no longer meeting its goal of providing rapid access to care, General Internist at PRH, Dr Chad Dyck, led a quality improvement project to better understand the barriers and redesign the referral process with support from Specialist Services Committee’s (SSC) Facility Engagement.  

Rather than assuming where the delays were occurring, the project team examined the data and met with the people closest to the work. They reviewed referral and wait-time data, mapped the existing process, and spoke with frontline booking staff to understand why patients were getting stuck. They also compared their workflow with RACE clinics at other sites to identify opportunities for improvement. 

Their review revealed two key issues. First, physician referrals were routinely paused while patients completed a range of pre-tests—including ECGs, echocardiograms, Holter monitors, chest X-rays, and treadmill stress tests—creating unnecessary delays before patients could be assessed. Second, referrals were triaged through a registered nurse, a task that is outside the scope of the role. 

The solution 

Working together, the team redesigned the process map to reduce unnecessary pre-testing so physicians can assess patients sooner and order investigations based on clinical need. They also transitioned to a physician-directed triage model, ensuring referrals were reviewed by the appropriate clinician while allowing nursing staff to focus on work within their scope of practice. 

Impacts 

The changes produced meaningful improvements. Wait times for Priority 2 (P2) referrals dropped significantly, bringing the clinic closer to its target of seeing patients within seven days. Priority 3 (P3) consult-only referrals improved from approximately three months to just over one month, allowing patients to access specialist care much sooner. While wait times for patients requiring treadmill stress tests remained unchanged, the team identified testing capacity—not the referral process—as the primary constraint, providing a clear focus for future improvement efforts. 

Key takeaways and lessons learned: 

• Reliable data is essential for identifying problems and measuring progress. 

• Engaging frontline staff provides valuable insight into how processes work in practice and helps build sustainable change. 

• Ensuring the right people are doing work within their scope of practice can improve both efficiency and patient care. 

By simplifying the referral pathway and redesigning the triage process, the team improved access to timely cardiac assessment and created a stronger foundation for ongoing quality improvement at Penticton Regional Hospital.