Improving care for residents in long term care facilities experiencing an acute change in health status
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(2020) 20:1075
STUDY PROTOCOL
Open Access
Improving care for residents in long term care facilities experiencing an acute change in health status Abraham Munene1* , Eddy Lang1,2, Vivian Ewa1,2, Heather Hair2, Greta Cummings3, Patrick McLane2, Eldon Spackman1, Peter Faris2, Nancy Zuzic1,2, Patrick B. Quail1,2, Marian George4, Anne Heinemeyer2, Daniel Grigat2, Mark McMillen2,5, Shawna Reid2 and Jayna Holroyd-Leduc1,2
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. Keywords: Long term care, Mixed methods, Quality of care, Geriatrics, Long-term care, Emergency departments, Community Paramedicine
* Correspondence: [email protected] 1 Cumming School of Medicine, University of Calgary, University of Calgary South Tower 1403, 29th Street NW, Calgary, AB T2N 2T9, Canada Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third par
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