Related Experiment Video
Updated: May 24, 2026
Implementation of Non-invasive Point of Care Transient Elastography for Evaluation of Liver Disease in Pediatric Populations with Cystic Fibrosis
Published on: August 29, 2025
Reduced wait times for hepatology referrals in a prospective quality improvement initiative
Ofodile Joe-Uzuegbu1, Yashasavi Sachar2, Abdel Aziz Shaheen1
1Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Insights
A quality improvement project significantly reduced hepatology referral wait times by implementing a multi-component strategy. This initiative improved access to care for routine liver disease referrals and backlog reduction.
Area of Science:
- Hepatology
- Quality Improvement
- Healthcare Access
Background:
- Increasing waitlist volumes for hepatology referrals due to population growth and rising chronic liver disease.
- Prolonged wait times threaten timely surveillance, diagnosis, and treatment for liver conditions.
- Quality improvement project conducted in a tertiary clinic utilizing a central access and triage (CAT) system.
Purpose of the Study:
- To reduce the median wait time for routine hepatology referrals by 50% (from 78.4 to 39 weeks).
- To improve urgent and emergent wait times and decrease the overall waitlist size.
- To implement a data-driven strategy within a CAT model to enhance patient access.
Main Methods:
- Six Plan-Do-Study-Act cycles targeting referral coding, dedicated HBV clinic, triage criteria, waitlist management, and capacity expansion.
- Recruitment of two additional hepatologists to increase service capacity.
- Analysis of referral data using statistical process control (SPC) charts to monitor wait times and waitlist accrual.
Main Results:
- Median routine referral wait time decreased from 78.4 to 8.4 weeks.
- Urgent wait times reduced from 28.3 to 6.6 weeks; emergent wait times remained near the 2-week target.
- Total waitlist size decreased from 1426 to 158 patients, with sustained negative net accrual indicating backlog reduction.
Conclusions:
- A multi-component, data-driven strategy within a CAT model significantly improved access for routine hepatology referrals.
- The strategy effectively protected timely care for higher-acuity patients.
- The approach demonstrates potential applicability to other subspecialty clinics facing similar access challenges.
Background:
Waitlist volumes for hepatology referrals in Calgary, Alberta, have increased with population growth and rising chronic liver disease [alcohol-related, metabolic dysfunction-associated steatotic liver disease, hepatitis B virus (HBV) infection, and cirrhosis complications]. Prolonged waits threaten timely surveillance, diagnosis, and treatment. We conducted a QI (quality improvement) project in the Calgary Liver Unit at the University of Calgary Medical Clinic (UCMC), a tertiary clinic using a central access and triage (CAT) system serving ~2 million residents.
Methods:
Our aim was to cut the median wait for routine referrals from 78.4 to 39 weeks (50%) between October 2023 and August 2025. Six Plan-Do-Study-Act cycles targeted referral coding (ICD-10 groupings), a dedicated HBV clinic, clearer triage acuity criteria, standardized waitlist management, redirecting benign liver neoplasms to primary care with guidance, and recruiting 2 additional hepatologists to expand capacity. The primary outcome was median routine wait time; secondary outcomes included urgent and emergent wait times and total waitlist size. Net waitlist accrual (accepted referrals minus new patients seen per month) tracked the flow. Data from CAT and scheduling systems were analyzed using statistical process control (SPC) charts.
Results:
By August 2025, the median routine wait fell to 8.4 weeks, the urgent wait fell from 28.3 to 6.6 weeks, and the emergent wait remained near the 2-week target (2.4 to ~2.7 weeks). The waitlist decreased from 1426 to 158 patients, and net accrual shifted from persistently positive to sustained negative values, reflecting backlog reduction. Routine-wait SPC charts showed special-cause variation and a sustained performance shift after key interventions.
Conclusion:
This multi-component, data-driven strategy within a CAT model improved access for routine referrals while protecting timely care for higher-acuity patients and may translate to other subspecialty clinics facing similar constraints.
