Improving transitions in care is an important priority in
the health care system. To facilitate province-wide improvement on this issue,
a set of indicators related to timely and efficient transitions was included in
the 2019/20 Quality Improvement Plans (QIPs).
We recently held a webinar to share our observations from
the QIPs related to reducing potentially preventable emergency department (ED)
visits for long-term care residents. The webinar introduced this indicator and
summarized the work organizations are doing to improve in this area. Guest
speakers from St Mary’s General Hospital and Lanark Heights Long-Term Care
Centre also shared their experiences in working together to reduce potentially
preventable emergency department visits for long-term care residents in the
If you missed the webinar, you can view the recording or
slide deck, and a summary is presented below.
Why is this indicator
This topic is important to residents and their loved ones as
visits to the ED can be quite stressful. ED visits also come with health risks
and complications, including delirium, falls, hospital-acquired infections, and
functional decline. In addition, avoiding unnecessary transfers to hospital can
help to reduce hospital overcrowding.
Although residents of long-term care homes account for less
than 1% of ED visits, one in three residents had an ED visit; these visits were
commonly caused by injuries from falls (21.5%).
organizations doing to improve performance on this indicator?
522 long-term care homes reported that they are working on
this indicator in their 2019/20 QIPs. Initiatives to address this indicator
- Understanding and addressing root causes of ED
transfers through preventative care and early recognition and treatment (e.g.,
falls prevention and wound treatment)
- Educating residents and families on the
availability and value of receiving care within the home
- Increasing availability of in-home tests and
treatments (e.g., intravenous therapy)
- Collaborating with other organizations for
improvement (typically hospitals or other long-term care homes)
A poll conducted during the webinar indicated that attendees
most frequently reported working on early recognition of at-risk residents
(63%) and resident and family education (59%). Another poll for those who are
working on collaborations showed that most respondents are either well on their
way (37%) or having preliminary discussions (24%).
Spotlight on the KW4
The KW4 (Kitchener-Waterloo-Wilmot-Wellesley-Woolwich) Collaborative
is a group of local long-term care homes, hospitals and the LHIN that work
together to improve care in the region. Lucy Coulombe (St Mary’s General
Hospital and the Waterloo Wellington LHIN) and Debra Mann (Lanark Heights
Long-Term Care Centre) presented on how the KW4 Collaborative worked together
to reduce ED transfers from long-term care.
The KW4 Collaborative is co-chaired by representatives from
both hospitals and long-term care homes, and the location of the meetings
rotates between participating organizations. These meetings have enabled the
group to discuss difficult cases and ways to avoid transfer to the ED. Over
time, participants from different organizations got to know one another; now,
when a long-term care home is faced with a challenging case, they know who to
call at the hospital to discuss it before the patient is transferred.
Lucy and Debra highlighted a few important pieces of advice
for others considering similar collaborations:
- Teamwork must be a priority
- Logistical challenges associated with collaborative
work must be addressed, such as who will co-chair and where meeting minutes
will be stored
- Connections create learning; sharing examples
and stories, and being familiar with the different structures and workflows in
the different organizations is an important part of collaborative work
The webinar concluded with an active question period –
listeners were quite interested in the KW4 Collaborative and how they could
create a similar collaborative group. Check out the
webinar recording or slide deck to hear more advice from the KW4 Collaborative and
learn more about our observations from the 2019/20 QIPs.
If you’ve worked on improving transitions by partnering with
other organizations, we encourage you to share your tips or tools below!
Are you interested in
learning more about avoiding potentially preventable ED visits?
For more change ideas and tools, check out the Indicators
& Change Ideas page for the potentially preventable ED visits indicator.