Reduced wait times for hepatology referrals in a prospective quality improvement initiative

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.