(P68) Improving ED Transfers for Long-Term Care Residents: A Care Pathway

Introduction/

Objective: Nearly half of all long-term care (LTC) residents in Canada are transferred to the emergency department (ED) annually, increasing the strain on healthcare resources and potentially negatively impacting the health and wellness of residents (e.g., exposure to iatrogenic harms). Many residents’ conditions could be managed within LTC if appropriate supports were provided. The aim of this knowledge translation project was to reduce potentially avoidable transfers from LTC to ED and provide care for residents within LTC homes in Calgary, Alberta, Canada.

Design/Methodology: Between October 2019 and April 2022, 40 LTC homes and 4 EDs within the Calgary health zone (catchment area of 1.4 million) implemented a standardized LTC-to-ED care and referral pathway supported by a centralized telephone triage system, community paramedics, and early identification tools for acute medical issues (INTERACT® tools). Using a randomized stepped-wedge design, the pathway was sequentially implemented within nine cohorts of (4-5) LTC facilities every three months supported by an implementation coach. Three-hour train the trainer implementation sessions were conducted in-person and online with over 325 health practitioners in the enrolled LTC homes using strategies adapted to address local context and barriers, as well as pandemic-related challenges.
Evaluation of the intervention involved mixed methods with the primary outcome of interest being the change in the rate of transfers from LTC to ED. For the primary and quantitative secondary outcomes, incident rate with 95% CI (per 1000 residents) were estimated using negative binomial regression, while adjusting for the different cohorts.

Results: Preliminary results demonstrate a reduction in the LTC-to-ED transfer rate (1.70 (95%CI 1.62-1.79) vs 1.92 (95%CI 1.85-1.99), along with reduction in hospital admission rates (0.91 (95%CI 0.85-0.96) vs 1.03 (95%CI 0.99-1.08)). There was no increase in the number of community paramedic visits (2.36 (95%CI 2.18-2.55) vs 2.94 (95%CI 2.81-3.08) or change in utilization of the telephone triage system (0.08 (95%CI 0.07-0.10) vs. 0.08 (95%CI 0.07-0.10)).

Conclusion/

Discussion: Implementation of a standardized LTC-to-ED care and referral pathway resulted in a reduction in ED transfers. However, reduction in transfers was not supported by an increase in use of the centralized telephone triage system or onsite community paramedics intervention. LTC staff education and use of early warning tools for acute medical issues (INTERACT ® tools) may have played a bigger role. Qualitative (measuring resident, family and healthcare provider perspectives) and cost analyses are underway.