One in five British Columbians is a senior; that ratio is projected to rise to 1:4 by 2041. This rapid increase in the age of our population has tremendous implications for our health-care system and nowhere is this felt more than at VGH’s Rapid Access Geriatric Clinic. To help reduce wait times for the clinic, Geriatrician Dr. Mark Fok applied for funding from VPSA’s Small Steps, Big Idea initiative.

The clinic provides comprehensive geriatric assessments for seniors with frailty and multimorbidity. By preventing and helping manage issues such as dementia, falls, and comorbidities, it aims to keep seniors at home for as long as possible, and as functional as possible.

“Clients were facing a six- to eight-month waitlist due to a multitude of factors including increased referrals from Emergency and Community, a rapidly aging population, and more medically complex and frail seniors,” said Dr. Fok. “Project funding reimbursed team members for time spent looking at factors to try to reduce the waitlist and thus reduce complications and hospitalizations.”

Dr. Fok shared that in 2015 the clinic saw 423 new patients over the entire year. By 2023, that number had increased to 129 new consults per month. That rose to 152 new consults per month by 2024.

Using VPSA funding, Dr. Fok and other clinic physicians Drs. Ken Madden, Larry Dian, Naaz Parmar, Gurmeet Sohi, Robynn Lester, Maria Chung, Diane Villanyo and Marion McKay Dunn implemented a quality improvement approach to reduce wait times to a sustainable level. Their goal was a 50 per cent reduction within 12 months.

“Process mapping revealed that our system could not reliably capture the required data to make the necessary measurements,” said Dr. Fok. “There were two concurrent electronic medical record systems being used, multiple front desk staff changes, and poorly defined workflows.”

Several tangible deliverables were then set up to help the clinic capture accurate outcomes:

• The clinic transitioned from dual EMR systems to Cerner only. This enabled centralized referral tracking and consistent wait-time measurement.
• The clinic created a central triaging system. This allowed the team to prioritize urgent referrals.
• The team established a focus group of geriatricians. An outcome of this was the decision to dedicate a separate clinic line to be staffed by geriatricians started in July 2026.
• Rapid Access Geriatric Clinic leaders met with leadership from the outpatient clinic. They were able to discuss issues and concerns; one outcome was a positive change regarding front desk staffing.
• Fok met with VCH analytics staff. Together they have established dashboards and metrics to capture wait times for triaging.

“Working with Norman Trinh in VCH Clinical Informatics, we were able to show dashboards of clinic volumes to establish baselines and measurements for the future,” said Dr. Fok. “The figure below shows the volume of ambulatory clinic visits in 2025 and how visits to our clinic have increased significantly year over year.”

Tracking the origin of referrals led to the discovery that 14 per cent of clinic visits in 2025 were from clients who live in Fraser Health, which has its own geriatric clinics. This led to the VGH Rapid Access Geriatric Clinic implementing a redirect policy for referrals to be seen in Fraser Health and limiting the clinic to residents of Vancouver.

“While we were not able to achieve our primary outcome of reducing our waitlist by 50 per cent over 12 months due to system issues, the changes made to our workflow and the dashboards created for tracking set us in good stead for the future,” concluded Dr. Fok. “VPSA’s support throughout the project was very helpful and much appreciated. I encourage other VPSA members to apply for funding. It truly can make a significant difference.”