Transformative cardiac care model streamlines procedures and reduces wait times



The Challenge

The Fraser Health Cardiac Service program delivers cardiac care to a region of 1.7 million people, implanting more than 1400 cardiac electrical devices (pacemakers) a year. Growing demand for services was placing pressure on the system. Care was fragmented and not aligned with the cardiac services strategic plan. The cardiac service lacked dedicated operating room times, which led to challenges in coordinating clinical resources. Human resource constraints were resulting in unexpected cancellations of procedure implant days. Wait times were above benchmarks for both inpatients and outpatients—61 percent of inpatients had to wait more than 48 hours and 78 percent of outpatients had to wait more than six weeks. With a rapidly growing and aging population, challenges were expected to mount if changes weren’t made. Fraser Health quickly identified transforming the delivery of care for the cardiac device population as a high priority quality and safety initiative.

The Improvement Project

Noting the limited coordination and communication between stakeholders and facilities, as well as space and budget constraints, EXTRA lead Minnie Downey, Program Director, Cardiac Services at Fraser Health, with the support of an engaged cardiac and surgical services front-line team and other key stakeholders, used an evidence-informed framework to guide her CFHI-supported improvement project. Downey and her team focused on improving patient access to services, consolidating implant sites, and enhancing the efficiency of scheduling device implants and replacements. Pre- and post-procedure care—including clinical practice tools, processes and inventory management—was standardized and integrated across Fraser Health’s twelve sites in accordance with evidence informed practices. “Feedback from all internal stakeholders was key to the success of this project,” says Downey. The team developed and implemented a regional consolidated device implant program, called ICED (Implantable Cardiac Electrical Devices) that revolves around the centralized intake model with a standardized reporting system to monitor, track and adjust cases.To address the shortage of clinical experts, the model replaces an anesthesiologist with specially trained nursing personnel during pacemaker implants, for patients who meet defined criteria. Additionally, services for about 64 percent of patients who are preselected based on suitability are now performed in an outpatient surgical facility.

The Impact

Within six months of implementation, the ICED program consolidated and standardized cardiac services across the health authority from four sites to two. Cardiac implants increased from 22 per week to 30 per week, the waitlist was reduced from 120 to 40 patients and there were no cancelled procedure days due to lack of staffing. New wait time targets were met 80 percent of the time, resulting in a majority of inpatients receiving implants within 48 hours. Additionally, staff and patient feedback on the new care model and service has been positive.

The ICED program transformed both people and the system, with stakeholders from different sites now working collaboratively and finding opportunities to enhance patient care beyond the project requirements. Having set the standard for cardiac device implantation, Fraser Health Cardiac Services has since shared the success of ICED in a review conducted by the Provincial Health Service Agency in British Columbia, where work is currently underway towards the development of a province-wide plan.



Minnie Downey
Program Director
Cardiac Services at Fraser Health Authority
Vancouver, BC


To learn more about this project or the EXTRA program, visit or email us at