Cardiac rehabilitation (CR) is standard practice in Australia after a cardiac event and the referral process is considered automatic for eligible patients. Whereas, in the United States, the referral is at the physician's discretion and less than 20% of patients participate. This study investigated the impact of streamlining the referral process to a hospital-based outpatient CR program by modifying the inpatient cardiac discharge order to include an automatic referral for eligible cardiac patients unless otherwise indicated by the discharge physician. Consequently, the onus was now on the physician to deny rather than refer the patient to CR. The CR staff received copies of every discharge order to expedite the referral process. A signed referral was then obtained from the patient's assigned cardiologist in the outpatient clinic. A descriptive analysis compared the number of referrals over two 3-month periods (January-March) over consecutive years (2005 & 2006). All of the referred patients had either coronary artery disease (77%) or another related cardiac diagnosis. Results indicated there was a 15% increase in referrals to CR after the introduction of the modified discharge order. There were 107 referrals (62% male) in 2005 versus 126 referrals (57% male) in 2006. It appears that a more streamlined referral process may not only increase the number referrals, but also potentially expedite an invitation to outpatient CR and make it easier for physicians to refer.