Rapid Access in Neurosurgery (RAIN) Clinic: Successes and Challenges

OBJECTIVES: The Canadian healthcare system faces a critical access block, with neurosurgical wait times reaching a median of 49.9 weeks from referral to treatment. This study evaluates the impact of the Rapid Access in Neurosurgery (RAIN) Clinic, a rapid access ambulatory model on reducing specialist wait times and diverting non-emergent cases from overburdened emergency departments (EDs). METHODS: A prospective analysis was conducted on 2,979 patients referred to the RAIN Clinic at the University Health Network between April 2024 and December 2025. Key metrics included the referral-to-consultation interval, diagnostic distribution, clinical disposition (surgical vs. conservative management) and patient satisfaction. RESULTS: The RAIN Clinic achieved a median referral-to-consultation wait time of 9 days (interquartile range (IQR) 6-15). The most common diagnoses were radiculopathy/myelopathy (41.3%) and brain tumors (13.4%). Clinical disposition data revealed that 79.9% of patients were managed conservatively or discharged to primary care, while 11.7% were triaged directly to elective surgery. Critically, only 0.54% of patients required immediate ED transfer, suggesting the model safely identifies and manages high-acuity patients in an outpatient setting. CONCLUSIONS: The RAIN Clinic serves as a vital pressure valve for the healthcare system, providing a scalable blueprint for reducing ED congestion and specialist bottlenecks. By compressing the assessment timeline from months to days, the model optimizes resource allocation, improves patient throughput, and ensures timely intervention for subacute neurosurgical conditions.