The FAST Program: Improving Patient Access to General Surgery

Student Researcher:
Marissa Burns

Supervisor / Principle Investigator:
Jonathan White

MD Class of 2021


Introduction: Inefficiencies in referral systems from primary to specialist care contribute to delays in surgical diagnosis and treatment. These delays are associated with adverse patient outcomes and suboptimal use of resources. Centralized referral (CR) is a strategy that seeks to optimize the flow of referrals by using a central mechanism through which referrals are received, screened, and distributed. To handle requests for surgical consults more efficiently, a CR program was implemented at the Royal Alexandra Hospital in November 2015. The purpose of this study was to describe the development of this CR program, to assess the effects of its use on patient access to care, and to evaluate stakeholder attitudes towards its implementation.

Hypothesis: Introduction of this CR system will increase referral capacity, and decrease time to consultation with a general surgeon.

Methods: A mixed-methods approach was used. Quantitative data included referral volume and time from referral to consultation. A retrospective comparison was conducted using data from before and after CR introduction. Data prior to the program’s implementation was obtained through retrospective chart review, and later data was obtained from the CR database. Qualitative data was collected using semi-structured interviews and analyzed using template analysis.

Results: Since implementation, 7316 referrals have been received from over 900 family physicians. Comparative data showed an increase in total appointments from 274 pre-implementation to 547 post-implementation. Median time to consultation has decreased from 118 to 108 days. Analysis of 36 stakeholder interviews revealed the experience of change, advantages of this system, and future improvements.

Conclusions: Introducing a CR system in general surgery has led to increased patient access to care and was accepted by key stakeholders.