London Transfer Project: improving handover documentation from long-term care homes to hospital emergency departments

Abstract

About one-quarter of all long-term care (LTC) residents are transferred to an emergency department (ED) every 6 months in Ontario, Canada. When residents are unable to describe their health issues, ED staff rely on LTC transfer reports to make informed decisions. However, transfer information gaps are common, and may contribute to unnecessary tests, unwanted treatments and longer ED length of stay. London Health Sciences Centre, an academic hospital system in London, Ontario, partnered with 10 LTC homes to improve emergency reporting of their residents' reason for transfer and baseline cognition. After conducting a root cause analysis, 7 of 10 homes implemented a standard minimum set of currently available transfer forms, including a computer-generated summary of resident's most recent interRAI functional assessment. Results were analysed using statistical process control charts and data were posted on a public website (LondonTransferProject.com). The documentation rate of 'reason for transfer' improved from 61% to 84%, and 'baseline cognitive status' improved from 4% to 56% across all 10 homes. These results suggest that transfer communication can be improved by codesigning and implementing solutions with ED and LTC staff, which build upon current reporting practices shared across multiple LTC organisations.

Keywords: communication; emergency department; nursing homes; quality improvement; transitions in care.

Figure 1

LTC Home nurses brainstorm and voteon the most common perceived barriers to emergency transfer documentation. ED, emergency department; EMR, electronic medical record; LTC, long-term care; RN, registered nurse; DNR, do-not-resuscitate; EMS, emergency medical services (ambulance); POA, power-of-attorney.

Figure 2

Statistical process control p-charts: outcome measures. CL, centre line; ED, emergency department; LCL, lower control limit; LTC, long-term care; UCL, upper control limit.