Posted on May 27, 2025
Urgent appointments are being dealt with more appropriately—in clinic rather than hospital—in Central Saanich thanks to the physician quality improvement project led by family physician Sienna Bourdon.
Dr Bourdon noticed that Saanich Peninsula Hospital emergency room (ER) was being overwhelmed in 2022-23, with more than 1,000 patient visits for medical issues that could potentially have been treated at the Shoreline Medical clinics.
Although the clinic had rapid-access appointments available, many of the visits to the ER for less urgent issues were patients who had a family doctor or nurse practitioner. Rapid access refers to same or next-day visits for urgent issues such as ear infections, abdominal pain, cough, fever, falls, or fractures.
“In our hospital and a lot of hospitals across the country, the emergency rooms are totally overrun right now, and patients are going to the emergency room for things we can manage at the clinic,” Dr Bourdon says.
Dr Bourdon’s project is funded by the Specialist Services Committee (SSC), which helps specialist physicians develop leadership and quality improvement skills to effectively lead and champion change. The Physician Quality Improvement (PQI) program aims to enhance physician capacity more broadly, recognizing the interdependence of family and specialist physicians. Family physicians participating in PQI projects receive compensation for their time from the Family Practice Services Committee (FPSC).
Dr Bourdon started her work by engaging with both patients and team members, using Shoreline Medical’s Brentwood clinic as a test site. After surveying more than 500 patients— she sent an email and survey link through the clinic’s secure portal—she quickly realized most people didn’t know there were rapid-access appointments available, how to access them, or what illnesses were appropriate for the clinic versus the emergency department.
“There was a major communication and knowledge gap in the patient population in terms of where to get their care,” she said.
Patients who did know were finding it difficult to get into the clinic because the rapid-access spots had already been booked for non urgent patients. Although every doctor had two such appointments available every day, they were being booked inappropriately—some of them for patients two weeks out—as the clinic had no clear rapid-access guidelines to be followed by physicians or medical office assistants (MOA).
“That caused a lot of distress for our staff,” Dr Bourdon says.
She focused the work on two areas: implementing new guidelines to ensure rapid access appointments were available, and patient intervention and communication.
“We hadn’t educated the staff or the patients about those appointments,” she says.
As part of the program, Dr Bourdon paired her work with FPSC and HealthLink BC’s After Hours Care (AHC) program. In this program, attached patients of family physicians and nurse practitioners participating in AHC receive medical care from a family physician when appropriate. Physicians are available from 5 pm to 9 pm during the week and 24 hours on weekends and holidays.
“The big message was ‘Call the clinic first, before you go to emergency,’” Dr Bourdon says. “Many times, patients can avoid a hospital visit.”
Dr Bourdon says the program showed good results. Although the number of visits to the ER didn’t decline from her clinic’s patients, they did remain stable, while overall volumes to the ER from other local clinics went up 35 per cent during the six months.
At the same time, the percentage of inappropriately booked appointments in the rapid-access clinics declined from 25 per cent to just six per cent, which means patients were being seen more readily.
“The satisfaction in the staff in terms of ease of booking and ability to accommodate people went up significantly,” she says. “We got lots of positive patient feedback, too.”
Shoreline Medical Clinic is now implementing the guidelines at its Sidney site, and it is being spread to other clinics in the Primary Care Network, Dr Bourdon says. She has also been invited to the Kelowna Division AGM to present her work.
Dr Bourdon says her Division and Island Health are prioritizing this work at local tables, which is needed as physicians in other divisions are facing the same problem.
“I feel badly when my patients have been to the ER for something I could have handled,” Dr Bourdon says. “The goal is to now spread these learnings to other clinics.”
The SSC and FPSC are two of four joint collaborative committees representing a partnership between the Government of BC and Doctors of BC, and include regular representation from health authorities.
