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Improving care for residents in long term care facilities experiencing an acute change in health status.
Munene, Abraham; Lang, Eddy; Ewa, Vivian; Hair, Heather; Cummings, Greta; McLane, Patrick; Spackman, Eldon; Faris, Peter; Zuzic, Nancy; Quail, Patrick B; George, Marian; Heinemeyer, Anne; Grigat, Daniel; McMillen, Mark; Reid, Shawna; Holroyd-Leduc, Jayna.
  • Munene A; Cumming School of Medicine, University of Calgary, University of Calgary South Tower 1403, 29th Street NW, Calgary, AB, T2N 2T9, Canada. abraham.munene2@ucalgary.ca.
  • Lang E; Cumming School of Medicine, University of Calgary, University of Calgary South Tower 1403, 29th Street NW, Calgary, AB, T2N 2T9, Canada.
  • Ewa V; Alberta Health Services, Calgary, AB, Canada.
  • Hair H; Cumming School of Medicine, University of Calgary, University of Calgary South Tower 1403, 29th Street NW, Calgary, AB, T2N 2T9, Canada.
  • Cummings G; Alberta Health Services, Calgary, AB, Canada.
  • McLane P; Alberta Health Services, Calgary, AB, Canada.
  • Spackman E; Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
  • Faris P; Alberta Health Services, Calgary, AB, Canada.
  • Zuzic N; Cumming School of Medicine, University of Calgary, University of Calgary South Tower 1403, 29th Street NW, Calgary, AB, T2N 2T9, Canada.
  • Quail PB; Alberta Health Services, Calgary, AB, Canada.
  • George M; Cumming School of Medicine, University of Calgary, University of Calgary South Tower 1403, 29th Street NW, Calgary, AB, T2N 2T9, Canada.
  • Heinemeyer A; Alberta Health Services, Calgary, AB, Canada.
  • Grigat D; Cumming School of Medicine, University of Calgary, University of Calgary South Tower 1403, 29th Street NW, Calgary, AB, T2N 2T9, Canada.
  • McMillen M; Alberta Health Services, Calgary, AB, Canada.
  • Reid S; Resident Family Advisory Council, AHS Emergency Strategic Clinical Network, Calgary, AB, Canada.
  • Holroyd-Leduc J; Alberta Health Services, Calgary, AB, Canada.
BMC Health Serv Res ; 20(1): 1075, 2020 Nov 25.
Article in English | MEDLINE | ID: covidwho-942237
ABSTRACT

BACKGROUND:

Long term care (LTC) facilities provide health services and assist residents with daily care. At times residents may require transfer to emergency departments (ED), depending on the severity of their change in health status, their goals of care, and the ability of the facility to care for medically unstable residents. However, many transfers from LTC to ED are unnecessary, and expose residents to discontinuity in care and iatrogenic harms. This knowledge translation project aims to implement a standardized LTC-ED care and referral pathway for LTC facilities seeking transfer to ED, which optimizes the use of resources both within the LTC facility and surrounding community. METHODS/

DESIGN:

We will use a quasi-experimental randomized stepped-wedge design in the implementation and evaluation of the pathway within the Calgary zone of Alberta Health Services (AHS), Canada. Specifically, the intervention will be implemented in 38 LTC facilities. The intervention will involve a standardized LTC-ED care and referral pathway, along with targeted INTERACT® tools. The implementation strategies will be adapted to the local context of each facility and to address potential implementation barriers identified through a staff completed barriers assessment tool. The evaluation will use a mixed-methods approach. The primary outcome will be any change in the rate of transfers to ED from LTC facilities adjusted by resident-days. Secondary outcomes will include a post-implementation qualitative assessment of the pathway. Comparative cost-analysis will be undertaken from the perspective of publicly funded health care.

DISCUSSION:

This study will integrate current resources in the LTC-ED pathway in a manner that will better coordinate and optimize the care for LTC residents experiencing an acute change in health status.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Quality of Health Care / Long-Term Care / Emergency Service, Hospital / Quality Improvement / Nursing Homes Type of study: Experimental Studies / Prognostic study / Qualitative research / Randomized controlled trials Limits: Aged / Humans Country/Region as subject: North America Language: English Journal: BMC Health Serv Res Journal subject: Health Services Research Year: 2020 Document Type: Article Affiliation country: S12913-020-05919-7

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Quality of Health Care / Long-Term Care / Emergency Service, Hospital / Quality Improvement / Nursing Homes Type of study: Experimental Studies / Prognostic study / Qualitative research / Randomized controlled trials Limits: Aged / Humans Country/Region as subject: North America Language: English Journal: BMC Health Serv Res Journal subject: Health Services Research Year: 2020 Document Type: Article Affiliation country: S12913-020-05919-7