Improving Specialty Care Access in Ontario Through Triaging Referrals to eConsult (TReC): A RE-AIM Evaluation

Challenges in access to specialty care in Canada lead to long wait times and poorer outcomes. The eConsult Centre of Excellence at The Ottawa Hospital (TOH) developed Triaging Referrals to eConsult (TReC), embedding specialist advice into routine referral workflows within health information systems (HIS). Following a successful proof-of-concept, TReC expanded to Women's College Hospital (WCH) in 2023 and the Children's Hospital of Eastern Ontario (CHEO) in 2025. We applied the RE-AIM framework to evaluate implementation across study the three study sites. Reach was assessed by utilization; effectiveness by response times and surveys; adoption by specialist participation; implementation by delivery and cost; maintenance by ongoing use. Data sources included administrative data and surveys of patients and providers. Specialist participation included 160 at TOH, 22 at WCH, and 26 at CHEO. Since launch, >10,000 eConsults were completed at TOH, >880 at WCH, and >360 at CHEO, spanning 15, 8, and 10 clinical areas, respectively. Median response times ranged from 2-8 days across sites, versus Ontario's 23-week average for in-person care. Median cost per TReC case was $37 CAD (10 minutes spent per case), substantially lower than in-person visits. Surveys showed high acceptability: 84% of referring providers at TOH and 91% at WCH found advice actionable; 70% of TOH patients felt concerns were addressed; and 91% of TOH specialists perceived TReC to improve access. TReC scaled successfully across three hospitals and improved timely access. High acceptability supports expansion and potential to improve equitable access across Ontario. Future evaluation will assess post-TReC healthcare utilization.