The impact of the COVID-19 pandemic on transfers between long-term care and emergency departments across Alberta

Abstract

Background: Long-term care (LTC) was overwhelmingly impacted by COVID-19 and unnecessary transfer to emergency departments (ED) can have negative health outcomes. This study aimed to explore how the COVID-19 pandemic impacted LTC to ED transfers and hospitalizations, utilization of community paramedics and facilitated conversations between LTC and ED physicians during the first four waves of the pandemic in Alberta, Canada.

Methods: In this retrospective population-based study, administrative databases were linked to identify episodes of care for LTC residents who resided in facilities in Alberta, Canada. This study included data from January 1, 2018 to December 31, 2021 to capture outcomes prior to the onset of the pandemic and across the first four waves. Individuals were included if they visited an emergency department, received care from a community paramedic or whose care involved a facilitated conversation between LTC and ED physicians during this time period.

Results: Transfers to ED and hospitalizations from LTC have been gradually declining since 2018 with a sharp decline seen during wave 1 of the pandemic that was greatest in the lowest-priority triage classification (CTAS 5). Community paramedic visits were highest during the first two waves of the pandemic before declining in subsequent waves; facilitated calls between LTC and ED physicians increased during the waves.

Conclusions: There was a reduction in number of transfers from LTC to EDs and in hospitalizations during the first four waves of the pandemic. This was supported by increased conversations between LTC and ED physicians, but was not associated with increased community paramedic visits. Additional work is needed to explore how programs such as community paramedics and facilitated conversations between LTC and ED providers can help to reduce unnecessary transfers to hospital.

Keywords: COVID-19; Community paramedics; Emergency department; Long-term care.

Fig. 1

Q1(A) Transfers from Long-term Care (LTC) to Emergency Departments (ED) and (B) admissions to hospital from January 1, 2018 until December 31, 2021. Colored bars indicate the waves of the pandemic and the dashed line indicates when vaccines were first administered to LTC residents

Fig. 2

Transfers from long-term care (LTC) to emergency departments (ED) stratified by Canadian Triage Acuity Scale (5 = lowest, 1 = highest) from November 1, 2019 until December 31, 2021. Shaded bars indicate waves of the pandemic. The dashed line represents when vaccines were first administered to LTC residents

Fig. 3

(A) Community paramedic (CP) visits to long-term care (LTC) facilities where residents were treated and not transported, (B) RAAPID facilitated LTC physician-to-ED physician calls regardless of disposition and (C) OLMC facilitated paramedic-to-ED physician calls at LTC facilities from November 1, 2019 until December 31, 2021. Colored bars indicate the waves of the pandemic and the dashed line indicates when vaccines were first administered to LTC residents