Characteristics of a Pilot Rheumatology Rapid Access Clinic in Toronto, Canada

Objectives Rapid Access Clinics (RACs) are designed to provide timely access to specialist care for patients with conditions requiring semi-urgent intervention and have been well described in other disciplines.[1,2] This descriptive analysis aimed to describe the care provided by a Rheumatology Rapid Access Clinic (RRAC) in Toronto Ontario, specifically the referral patterns, wait times, diagnostic outcomes, and patient dispositions.

Methods RRAC was established at St. Michael’s Hospital (SMH) in September 2022 to provide care for patients with semi-urgent conditions referred from the SMH Emergency Department, family practice units and subspecialty clinics. Referral criteria included patients with inflammatory arthritis (acute mono/polyarthritis, crystalline arthropathies), systemic autoimmune rheumatic diseases, vasculitis, polymyalgia rheumatica, and acute non-inflammatory conditions. Long-term rheumatology care was not provided in the RRAC. A retrospective chart review was conducted for all new patient referrals to the RRAC from September 2022 through October 2024. Extracted data included demographics, referral source, diagnosis, time from referral to consultation date provided, number of RRAC follow-up visits, and final patient disposition. Descriptive statistics summarized patient characteristics.

Results The RRAC database included 334 patient referrals, of which 305 (92%) were seen in consultation and 26 (8%) who did not attend. The mean age of patients seen was 57 years (range 20-98) with 56% being female (184). The most common referral sources were family health teams (31.1%), specialty clinics (22.8%), and the emergency department (20.1%). Median wait time from referral to consultation date was 10.2 days (mean 7.5), with 33 patients (11.1%) seen on the same day. Inflammatory conditions were diagnosed in 61% of referred patients, with detailed diagnostic outcomes summarized (Table 1). Follow-up in the RRAC was deemed necessary for 180 patients (59%), with a mean of 1.54 visits per patient. Final disposition included referral to long-term rheumatology care (43%), discharge to family health teams (27%), referral to specialty care (16%), and inpatient admission (0.99%).

Conclusion Implementation of the RRAC at SMH improved timely access for semi-urgent patients, with wait times to consultation date well below Canadian Rheumatology Association benchmarks.[3] The RRAC successfully prioritized patients with inflammatory conditions, ensuring early diagnosis and treatment initiation. By focusing on triage, assessment, and short-term follow-up, the clinic preserved long-term rheumatology capacity. These findings support RRACs as a scalable strategy to address access gaps in rheumatology care. Future studies should evaluate patient-reported outcomes and cost-effectiveness to inform integration of RRACs into broader healthcare frameworks.

References [1.] Nene S. World J Gastroenterol 2020;26:759-69. [2.] Fox D. Rural Remote Health 2023;23:8098. [3.] Widdifield J. Healthc Policy 2021;16:119-34.