Theme 7. Clinical innovations keeping people at home and out of the hospital
Presentation Materials (members only)
Learning Objectives
The objectives are to share lessons learnt from the pilot project including:
- Establishing shared milestones/goals with stakeholders in acquiring real-time data to inform rapid-cycle changes and perform program evaluation.
- Diversifying activities decreases risk of over-relying on a particular strategy - Program resilience is a key requirement for success. Accordingly, we have developed parallel activities (i.e. Nurse Practitioner support, telemedicine case conference rounds, knowledge translation materials, and quality improvement), in order to support our pilot LTC homes.
- Impact of pilot:
- Potential for healthcare sustainability – Estimated cost savings approx $70K (In the first 10 clinical days, the NP was able to change LOC for 6 of 13 residents, eliminating future ER transfers for the subsequent 6 months).
- Resident outcomes – improved pain and symptom management, in-house palliation (avoiding stressful transfers at the end of life, respect for wishes and best interests
- Support for families – goals of care enables proactive care plan development.
Summary
Seniors suffer from increased morbidity and mortality when transferred to hospital versus receiving care in their place of residence. In long-term care (LTC) 25-55% of transfers to the Emergency Room (ER) are potentially avoidable and a 15% reduction in Ontario could save over $76 million per year. US & UK QI initiatives have shown 17-25% reduction in ER transfers. The Integrated Long Term Care (ILTC) program, recently featured in the Ontario Medical Review (April 2015), is composed of 3 pillars – capacity building, access to specialist consults, and acute care provision. Juxtaposed to the supporting evidence for the program, there have been some challenges in the first year of implementation. These include identification of a target population, nurse practitioner recruitment and retention, competing demands for staff on the floor, need for palliative care training for front line staff and family's insistence of ER transfer. Each of these challenges has an associated mitigation strategy which will be discussed during the presentation, as will next steps for the program.
Presenters
- Candy Lipton, Vice President, Operations, Sienna Seniors
- Irene Ying, MD, Palliative Care Consultant, Sunnybrook Health Sciences Centre; Assistant Professor, University of Toronto DFCM
Authors and Contributors
- Joe Pedulla, CHE, RRT, ACP MHSc, BASc, BSc
- Candace Tse, MHSc
- Jason Xin Nie