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Indicators & Change Ideas

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Explore the quality indicators being tracked by health care organizations in Ontario through Quality Improvement Plans (QIPs) and change ideas to help improve them. Connect with others to share your experiences and ideas of your own.

INDICATORS & CHANGE IDEAS

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Rate of potentially avoidable emergency department visits for long-term care residents

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Avoidable emergency department (ED) visits pose significant clinical risks, stress, and anxiety for older, vulnerable residents in long-term care homes. Such visits can often be disruptive, leading to adverse health outcomes, including hospital-acquired infections, delirium, and a decline in functional abilities. Overcrowding and escalating costs in hospital EDs in Ontario have long been a concern, highlighting the need for a comprehensive strategy to manage avoidable transfers from long-term care homes. Strengthening in-home care capabilities, improving staff training, and enhancing care coordination are critical to address this pressing issue from all angles.

Key resources

Change Ideas

Educate staff, residents, and families about the benefits of preventing ED visits and the services the home has to manage care within the home

  • Enhance staff training on early recognition and management of common conditions that may result in ED visits, such as infections and dehydration
    Preview ED Observation Tool
  • Educate staff on effective communication techniques between members of the health care team and external clinical supports about a resident’s condition
    SBAR Tool; SBAR example
  • Strengthen fall prevention programs to reduce injury-related ED visits by using environmental modifications, regular assessments, and mobility aids
  • Increase access to on-site diagnostic tools, tests, and treatments (e.g., x-rays, ultrasounds, bladder scanner, lab tests, intravenous therapy) to manage conditions within the home
  • Introduce virtual consultations for nonurgent health concerns to provide residents with timely care
  • Work collaboratively with clinical supports, such as nurse-led outreach teams at local hospitals, nurse practitioners supporting teams averting transfers, and on-site nurse practitioners, to deliver education, training, and clinical guidance to home staff and participate in decisions to transfer a resident to a hospital
  • Enhance palliative approach to care within the long-term care home
    Strengthening a Palliative Approach in Long-Term Care
    LEAP – Learning Essential Approaches to Palliative Care offered by Pallium Canada
  • Complete advance care planning and ensure all residents have up-to-date care directives to guide decision-making and reduce unnecessary hospital transfers
  • Involve the resident and their family, care partner or substitute decision-maker in care conferences to review care plan goals and preferences, particularly around end-of-life care

Resources for Health Care Professionals

  • Use evidence-based tools to identify residents who would benefit from a palliative approach to care
    The Ontario Palliative Care Network’s Tools to Support Earlier Identification for Palliative Care outline recommended tools that can be integrated into various care settings
  • Implement an evidence-based model of care for providing palliative care in long-term care
    The Ontario Palliative Care Network’s Palliative Care Health Services Delivery Framework outlines recommendations to guide the organization and delivery of palliative care and includes a patient pathway
  • Provide access to evidence-informed tools to support long-term care clinicians with palliative care delivery. Resources should include:
    Palliative care or comfort care order sets (typically, these are facility specific and established locally)
    Symptom management guides
    - e.g., The BC Centre for Palliative Care’s Inter-professional Palliative Symptom Management Guidelines, Ontario Health’s symptom management guidelines
    Resources to support serious illness conversations and Goals of Care discussions:
    - Ariadne Lab and the Dana-Farber Cancer Institute’s Serious Illness Conversation Guide
    - Speak Up Ontario’s Just Ask: A Conversation Guide for Goals of Care Discussions
    - Guide and template for Documenting Goals of Care discussions
  • Consider supplemental education on pain and symptom management and skills training to support goal of care discussions to help build capacity within the home
  • Build linkages with community palliative care partners to supplement long-term care staff and create more specialized palliative care knowledge and skills in long-term care homes. Providers and organizations to engage include:
      • Palliative pain and symptom management consultants
      • Local hospice residences
      • Nurse-led outreach teams
      • Paramedics and palliative care programs

Rate of potentially avoidable emergency department visits for long-term care residents

0 Comments

Avoidable emergency department (ED) visits pose significant clinical risks, stress, and anxiety for older, vulnerable residents in long-term care homes. Such visits can often be disruptive, leading to adverse health outcomes, including hospital-acquired infections, delirium, and a decline in functional abilities. Overcrowding and escalating costs in hospital EDs in Ontario have long been a concern, highlighting the need for a comprehensive strategy to manage avoidable transfers from long-term care homes. Strengthening in-home care capabilities, improving staff training, and enhancing care coordination are critical to address this pressing issue from all angles.

Key resources

Change Ideas

Educate staff, residents, and families about the benefits of preventing ED visits and the services the home has to manage care within the home

  • Enhance staff training on early recognition and management of common conditions that may result in ED visits, such as infections and dehydration
    Preview ED Observation Tool
  • Educate staff on effective communication techniques between members of the health care team and external clinical supports about a resident’s condition
    SBAR Tool; SBAR example
  • Strengthen fall prevention programs to reduce injury-related ED visits by using environmental modifications, regular assessments, and mobility aids
  • Increase access to on-site diagnostic tools, tests, and treatments (e.g., x-rays, ultrasounds, bladder scanner, lab tests, intravenous therapy) to manage conditions within the home
  • Introduce virtual consultations for nonurgent health concerns to provide residents with timely care
  • Work collaboratively with clinical supports, such as nurse-led outreach teams at local hospitals, nurse practitioners supporting teams averting transfers, and on-site nurse practitioners, to deliver education, training, and clinical guidance to home staff and participate in decisions to transfer a resident to a hospital
  • Enhance palliative approach to care within the long-term care home
    Strengthening a Palliative Approach in Long-Term Care
    LEAP – Learning Essential Approaches to Palliative Care offered by Pallium Canada
  • Complete advance care planning and ensure all residents have up-to-date care directives to guide decision-making and reduce unnecessary hospital transfers
  • Involve the resident and their family, care partner or substitute decision-maker in care conferences to review care plan goals and preferences, particularly around end-of-life care

Resources for Health Care Professionals

  • Use evidence-based tools to identify residents who would benefit from a palliative approach to care
    The Ontario Palliative Care Network’s Tools to Support Earlier Identification for Palliative Care outline recommended tools that can be integrated into various care settings
  • Implement an evidence-based model of care for providing palliative care in long-term care
    The Ontario Palliative Care Network’s Palliative Care Health Services Delivery Framework outlines recommendations to guide the organization and delivery of palliative care and includes a patient pathway
  • Provide access to evidence-informed tools to support long-term care clinicians with palliative care delivery. Resources should include:
    Palliative care or comfort care order sets (typically, these are facility specific and established locally)
    Symptom management guides
    - e.g., The BC Centre for Palliative Care’s Inter-professional Palliative Symptom Management Guidelines, Ontario Health’s symptom management guidelines
    Resources to support serious illness conversations and Goals of Care discussions:
    - Ariadne Lab and the Dana-Farber Cancer Institute’s Serious Illness Conversation Guide
    - Speak Up Ontario’s Just Ask: A Conversation Guide for Goals of Care Discussions
    - Guide and template for Documenting Goals of Care discussions
  • Consider supplemental education on pain and symptom management and skills training to support goal of care discussions to help build capacity within the home
  • Build linkages with community palliative care partners to supplement long-term care staff and create more specialized palliative care knowledge and skills in long-term care homes. Providers and organizations to engage include:
      • Palliative pain and symptom management consultants
      • Local hospice residences
      • Nurse-led outreach teams
      • Paramedics and palliative care programs
Aaron Miller True