Centralized referral system reduces wait times in Langley-based surgical clinic

Langley-based general surgeon and endoscopist Dr Scott Cowie is helping improve patient access to gastrointestinal (GI) care by reducing wait times in his high-volume surgical practice.

With funding from the Shared Care Committee, Dr Cowie and his team implemented a centralized referral system for GI endoscopy referrals at their five-physician surgical clinic, which receives more than 500 referrals each month, approximately 70% of them GI-related.

Known as a single-entry model (SEM), the system places all incoming referrals into one shared queue, using digital tools and standardized processes to improve access and create a more patient-centred referral pathway.

Reducing fragmentation

Before the project, referrals arrived through multiple channels with varying levels of information and inconsistent triage. As a result, wait times often depended more on how a referral entered the system than on the patient's clinical needs.

“The project addressed fragmentation by creating a shared intake pathway, standardizing the information required, introducing structured triage, and adding active nursing and clerical management around the queue,” said Dr Cowie. “From the patient perspective, that means less
uncertainty, fewer dropped steps, and a more coherent path from referral to consultation or procedure.”

Today, all referrals now enter through a single point of entry using a standardized GI referral form. This form aligns with the OceanMD eReferral platform to standardize intake and create a shared queue for referrals as a part of the Digital Referrals & Orders Program, a provincial platform that enables electronic referrals and orders. The clinic also updated its electronic medical records to support online self-scheduling.

Referrals are now reviewed within five days, with the care team assessing urgency and determining whether patients require an initial consultation or can proceed directly to endoscopy. While patients may still request a specific physician, pooled referrals can also be assigned to the next appropriate available surgeon through a transparent, rules-based allocation process.

The standardized process has reduced duplication and minimized missed handoffs and provides referring providers and patients with a more reliable pathway to care. Nursing and clerical staff can more actively manage overdue patients and emergency department referrals, reducing patient
stress and uncertainty.

Dr Cowie notes that implementing this project was a true partnership, involving the local clinical and operational team, including a GI nurse, Fraser Health, the Ministry of Health, and Doctors of BC. The project received funding from the Shared Care Committee—a partnership between the Province of British Columbia and Doctors of BC.

“Building on the success of similar projects in other BC communities, Langley added a high-volume GI surgical practice lens, combined with a strong digital and team-based workflow to support our local needs,” explained Dr Cowie.

The results

The new referral model produced significant improvements in access to care.

Referral-to-consult wait times and semi-urgent wait times fell by 30%, while decision-to-procedure wait times for urgent patients decreased by 71%. The clinic's waitlists are now more evenly distributed across its five surgeons, reducing the number of overdue patients. Approximately 15% of patients now choose the "first available physician" option, helping maximize available capacity.

The expanded nursing role also improved equity in practical ways. Patients referred by the emergency department, overdue patients, and direct-to-endoscopy patients received active outreach. This is especially important for patients who are vulnerable or disconnected from longitudinal primary care.

Digital improvements, including electronic referrals and self-scheduling, have also reduced administrative workload while improving the patient experience. Patient satisfaction surveys showed improvements in both timeliness and communication, with overall satisfaction exceeding 90%.

For physicians considering a similar approach, Dr Cowie emphasizes that the work involves much more than changing referral processes.

“This work is worth doing, but it is important to understand what kind of work it really is,” he said. “It is not just a way to move referrals around. It is a redesign of how access works in a constrained system. My advice would be to focus on the whole operating model and on long-term sustainability. Standardize intake, keep triage clinical, ensure there is nursing and clerical support around the queue, build measurement in early, and use digital tools where they genuinely improve flow and visibility.”

This project was funded by the Shared Care Committee, a partnership between the Province of British Columbia and Doctors of BC.