Women's College Research Institute

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Rates vary widely for how often long-term care homes transfer residents to the ED

Spring 2017

Many long-term care homes transfer residents to the emergency department at higher rates than average, according to an Ontario study published in the journal Healthcare Policy.

The study analyzed data from long-term care homes across the province. They found that the average home sent about a quarter of its residents to the emergency department at least once over the course of a year. Rates varied widely, however, and nearly a fifth of homes transferred so many of their residents they were considered "high transfer" homes. The highest transferred about 60 per cent of their residents at least once.

Andrea Gruneir, PhD, an adjunct scientist at Women’s College Research Institute (WCRI), and lead author on the study, said that long-term care home residents are expected to use the emergency department, but when rates are high, we need to ask why.

“The concern for individual residents is that their common medical conditions are not being adequately managed in the long-term care home,” Gruneir said, adding that it is important for homes to manage chronic conditions, such as diabetes, so they do not become worse, and to address sudden sickness like the flu. Gruneir co-authored the paper with WCRI adjunct scientist Susan Bronskill, PhD, and Dr. Paula Rochon, the vice-president of research at Women’s College Hospital.

Rates varied widely between homes, suggesting that the culture and policies at different institutions have a big effect on medical decisions. There was no significant difference in transfer rates between private and public homes. Smaller homes sent residents to the emergency department less often, which was surprising because larger homes often have more resources.

“We suspect that this may indicate that smaller homes may be more flexible than larger ones. In that sense, they may have fewer policies around exactly when someone needs to be transferred to the emergency department,” Gruneir said. However, she said that long-term care facilities of all sizes should look closely at when they transfer residents and why, and see where they can improve.

Next, the researchers will study data on residents who are transferred to the emergency department multiple times in a year.

“My biggest goal is to improve the quality of life for long-term care residents,” Gruneir said. “A lot of people already work very hard to take the best care of residents. Now, they need a climate that enables them to do even better and improve where they can.”

This research is an example of how WCH is contributing to a healthier, wealthier, smarter Ontario.

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