A Better Way to Care for Long Term Care (LTC) residents in Times of Medical Urgency: Improving Acute Care transfers for LTC Residents.

Background: Prior to the pandemic, every day approximately 28 long term care (LTC) residents were transferred an emergency department (ED) in Alberta. This was placing increasing strain on healthcare resources and potentially negatively impacting health wellness of (e.g., exposure iatrogenic harms). Many residents’ conditions could be managed within LTC if appropriate supports provided. Poor communication between EDs can also lead ED lengths stay, unnecessary resource utilization, sub-optimal outcomes, harms for residents. Two INTERACT® tools (tools early identification acute medical issues) a new referral pathway implemented help identify address changes status among sooner, improve providers, reduce transfers. Methods: Between October 2019 April 2022, 40 homes 4 Calgary zone standardized LTC-to-ED supported by centralized telephone advice transfer system community paramedics, two (Stop Watch aides; Change Condition Cards nursing). Using randomized stepped-wedge design, 9 cohorts (4-5) facilities 3 months, implementation coach. Three-hour train trainer sessions conducted in-person or online with over 325 practitioners enrolled using strategies adapted consider local context barriers, as well considering pandemic-related challenges. Evaluation intervention involved both qualitative quantitative methods. The primary study outcome is change transfers from ED; secondary (quantitative) outcomes include hospital admissions, utilization system, paramedic visits. Analysis these utilized negative binomial regression estimate incident rate 95% confidence intervals (per 1000 residents), while adjusting different cohorts. evaluation included economic analysis determine potential cost savings. Interviews providers provide their experience ways it improved. These interviews will interpreted involvement members our project resident family advisory council. Results: Quantitative results demonstrate reduction [1.70 (95%CI 1.61-1.79) post-intervention) vs 1.91 1.84-2.00) pre-intervention], along admission rates [0.94 0.88-1.00) 1.08 1.03-1.14)]. There increase [0.18 0.16-0.22) vs. 0.13 0.11-0.16)], but no number visits [2.05 1.94-2.16) 2.50 2.39-2.61)]. Cost data pending. Advice Lessons Learned: staff education use warning identifying (INTERACT® tools) and/or may have played role reducing We did not observe expected relationship reduced transfers, possibly result facility outbreak restrictions. Teams should tailor materials site specific needs contexts unique barriers facilitators. Partnerships key stakeholders across continuum are essential ensure adequate support effective uptake sustainability mutli-faceted intervention.