BackgroundThe LACE index was designed to predict early death or unplanned readmission after discharge from hospital to the community. However, implementing the LACE tool in real time in a teaching hospital required practical unavoidable modifications.ObjectiveThe purpose of this study was to validate the implementation of a modified LACE index (LACE-rt) and test its ability to predict readmission risk using data in a hospital setting.MethodsData from the Canadian Institute for Health Information’s Discharge Abstract Database (DAD), the National Ambulatory Care Reporting System (NACRS), and the hospital electronic medical record for one large community hospital in Toronto, Canada, were used in this study. A total of 3855 admissions from September 2013 to July 2014 were analyzed (N=3855) using descriptive statistics, regression analysis, and receiver operating characteristic analysis. Prospectively collected data from DAD and NACRS were linked to inpatient data.ResultsThe LACE-rt index was a fair test to predict readmission risk (C statistic=.632). A LACE-rt score of 10 is a good threshold to differentiate between patients with low and high readmission risk; the high-risk patients are 2.648 times more likely to be readmitted than those at low risk. The introduction of LACE-rt had no significant impact on readmission reduction.ConclusionsThe LACE-rt is a fair tool for identifying those at risk of readmission. A collaborative cross-sectoral effort that includes those in charge of providing community-based care is needed to reduce readmission rates. An eHealth solution could play a major role in streamlining this collaboration.

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In Canada, over 15,000 residents of long-term care have died from COVID-19 since the start of the pandemic representing 59 percent of all COVID-19 deaths (National Institute of Ageing, 2021). Urgent research and subsequent applied action are needed to save life and quality of life including the presence of family (CFHI, 2020). Social and physical frailty are major systemic patient safety gaps and are challenges for most healthcare organizations. This practitioner-led panel of experienced human factors, implementation science and healthcare experts used a case study of a project at North York General Hospital’s Seniors’ Health Centre in Toronto to discuss how these challenges can be addressed with serious games. The project discussed used games that aim to reduce social and physical frailty through exercise while interacting with remote families. Lessons learned to-date and challenges observed, in rapidly implementing safety and human factors programs intended to create resilient residents in a real healthcare context were discussed.