Assessing quality of older persons’ emergency transitions between long-term and acute care settings: a proof-of-concept study

Abstract

BackgroundLong-term care (LTC) residents frequently experience transitions in the location of more advanced care delivery, including receiving emergency department (ED) care. In this proof-of-concept study, we aimed to determine if we could identify measures in quality of care across transitions from LTC to the ED, via emergency medical services and back, by applying Institute of Medicine (IOM) Quality of Care Domains to an existing dataset.MethodsIn the Older Persons’ Transitions in Care (OPTIC) study, we collected information on residents’ transitions in two Western Canadian cities. We applied the IOM’s Quality of Care Domains to the OPTIC data to create binary measures of transition quality. We report the median (MED) per cent and IQR of measures met within each domain of quality.ResultsWe tracked 637 transitions over a 12-month period, with data collected from each setting. We developed 19 safety measures, 20 measures of resident-centred care, 3 measures of timely care and 5 measures of effective care. We were unable to develop measures for equitable care at an individual transfer level. Domain scores varied across individual transitions, with the highest scores in safety (MED 79%, IQR: 63–95), efficiency (66%; IQR: 66–99), and resident-centred (45%; IQR: 25–65), followed by effectiveness (36%; IQR: 16–56), and timeliness (0%; IQR: 0–50).ConclusionsOur results show variation in scores across the domains of quality suggesting that it is possible to track quality of transitions for individuals across all settings, and not only within settings. We recommend that future work in tracking quality of care be performed at several levels (LTC, region, health authority, province). Such tracking is necessary to evaluate and improve overall quality of care.

Strategies to Improve Emergency Transitions From Long-Term Care Facilities: A Scoping Review

“…Furthermore, researchers are not exploring how care delivery during the transition can be improved by interventions (and instead evaluate distal outcomes), and no study employed any frameworks related to transition care ( Aase & Waring, 2020 ) and/or domains of quality to evaluate care, such as Institute of Medicine’s Quality Domains ( Agency for Healthcare Research and Quality, 2002 ; Institute of Medicine (U.S.) Committee on Quality of Health Care in America, 2001). Employing these types of frameworks is needed for developing and applying measures to evaluate the effectiveness of interventions to improve transitions from RACF to the ED across various domains of quality (e.g., safety, person-centeredness, equity; Tate et al, 2022 ).…”

“…Older adults’ transitions from RACFs to the ED can result in poor outcomes related to functional decline, dehydration, infections, confusion, and loss of personal assistive devices ( Cline, 2016 ; Cummings et al, 2020 ; Rantz et al, 2015 ; Trahan et al, 2016 ). For decades researchers have identified various substandard RACF to ED transitions for the frailest of our populations and have expressed an urgent need to improve these transitions ( Adamczyk et al, 2018 ; Cummings et al, 2020 ; Tate et al, 2021 , 2022 , 2023 ). Challenges during transitions from RACFs to the ED include but are not limited to (a) difficulty coordinating care across various healthcare professionals from multiple care settings/cultures, (b) nonstandardized and insufficient documentation practices ( Bruce & Suserud, 2005 ; Coleman et al, 2003 ; Morphet et al, 2014 ; Tate et al, 2023 ), (c) communication challenges that are exacerbated when older persons cannot clearly express their care needs ( Page et al, 2010 ; Zimmerman et al, 2007 ), (d) atypical presentations when older people experience serious changes in health conditions ( Armstrong, 2015 ; Chandra et al, 2015 ), and (e) ageism through rationing and delayed care ( Adamczyk et al, 2018 ; Grief et al, 2013 ; Saif-Ur-Rahman et al, 2021 ; Van Wicklin.…”

The predictable crisis of covid-19 in Canada’s long term care homes

“…LTC is not well integrated with community care (such as primary care), other continuing care settings (such as retirement homes), or acute care (hospitals). These sectors largely ignore the frequent, important transitions across settings, including outbreaks 36. Many LTCHs did not have pandemic preparation plans (such as care plans for residents with covid, visitation policies, PPE access, IPAC support).…”

“…These sectors largely ignore the frequent, important transitions across settings, including outbreaks. 36 Many LTCHs did not have pandemic preparation plans (such as care plans for residents with covid, visitation policies, PPE access, IPAC support). In the first wave of the pandemic, acute care hospitals developed pandemic plans often without adequate consideration of impact on LTCHs such as PPE access.…”

The development and validation of a conceptual definition of avoidable transitions from long‐term care to the emergency department: A mixed methods study

“…Specifically, our definition can be used to develop structural and process indicators relevant to the intersection of healthcare services and professions, such as availability and timeliness of diagnostic testing, clinical assessment, and quality and clarity rather than just the existence of documentation around the reason for transition and advanced care planning 38,46. …”