Healthcare organizations and governments are exploring new methods to deliver cost-effective, quality care to the frail elderly. Given the projected increase in Canada's elderly population, ensuring that residents receive the right care, at the right time, in the right location is pivotal to this goal. Practical Routine Elder Variants Indicate Early Warning for Emergency Department has been developed as a quality improvement tool. Two pilot studies, one in Ontario and one in British Columbia, have shown promising results. Health leaders in acute care will benefit from improved Emergency Department (ED) utilization and less congested bed flow. Long-term care leaders can achieve fewer transfers to the ED, better quality outcomes, reduced costs from ED-acquired iatrogenic complications, enhanced communication with families, and improved staff confidence and morale. The health system benefits include reduced costs from fewer transfers and complications and enhanced collaboration between healthcare sectors.