Nurse-Led Outreach to Long Term Care Homes

1. Nurse-Led Outreach to Long Term Care Homes D. Ryan (RGP), C. Hatcher/M.L. McMaster (HRH/NYGH), P. Rosano/N. Fletcher (MacKZ/MSH) & R. Yamada (Southlake) LTCH Directors receive semi-annual reports customized to their homes detailing their resident EMS transports to EDs provided by Toronto, York and Simcoe EMS providers. Annual awards celebrate each regions LTCHs with overall lowest and most improved transport rates and The graphs below provide a summary of 2012/2013 data for all Central LHIN LTCHs. Throughout the province, overall EMS transports of seniors to Emergency Departments (EDs) are increasing. In several LHINs, Nurse-Led Outreach Teams (NLOT) providing emergency mobile nursing services to LTCH residents are helping to reduce these transport rates The NLOT team in the Central LHIN is comprised of 9 NP and other advanced practice nurses, strategically located in hubs at Humber River Regional/North York General Hospitals, Southlake Hospital, and Mackenzie Richmond Hill Hospital/Markham Stouffville Hospital. Coordination of the hubs and service evaluation is provided by the RGP of Toronto. The present poster provides an overview of the Central LHIN’s NLOT service and its accomplishments. NLOT services have three goals: 1) providing emergency care in the LTCH and reducing ED transports, 2) facilitating direct access to ambulatory care services without an ED admission, and 3) helping to the increase the capacity of LTCH staff to detect and manage acute changes of residents’ conditions as summarized below. NLOT nurses provide activity data that includes estimations of transfer avoidance. This table shows NLOT activity for 2012/13 fiscal year: • Building LTCH Capacity: • NLOT nurses provided 4,190 hours of capacity building with interprofessional LTCH staff • Capacity building aided by use of geriatrics simulation mannequins • Annual LTCH Directors education meeting focused on management of acute changes of residents’ conditions and available tools to support staff (SBAR, INTERACT II) • An annual NLOT Institute provided continuing education to NLOT staff and LTCH NPs across the region to enhance skills and increase competencies • An inaugural CME for LTCH attending physicians and medical directors focussed on NLOT and Behavioural Support Ontario services • Rapid face-to-face emergency nursing • Telephone coaching • Tele-consult during outbreaks • Identify acute change of resident condition • Support end of life care initiatives • Participate in rounds • Support attending physicians • Build staff confidence on complex procedures • Build partnerships to meet resident needs in such areas as IV management and tracheostomy • Facilitate hospital-LTCH repatriation and ALC reduction • Develop opportunities for access to clinics: • - Interventional radiology • - Video fluoroscopy • - Transfusion • Link with Geriatric Emergency Management (GEM) nurses • Facilitate inter-organizational information exchange LTCH participants’ ratings of NLOT helpfulness in 11 clinical areas: NLOT EMS transport data is used to evaluate NLOT outcomes. Below, is a summary of the impact of the teams by comparing pre-service data to the 2012/2013 fiscal year: A summary of NLOT stakeholder feedback ratings: SUMMARY: The RGP has helped develop this service in the CLHIN, TCLHIN, CELHIN and NELHIN. Each adapts to its own context but a common service model has emerged and outcomes seem consistently positive and highly valued. Emerging innovations include partnerships with EMS community paramedicine initiatives, developments in end-of-life/palliative care and facilitated access to ambulatory services. We recommend this service to all LHINs. For more information contact david.ryan@sunnybrook.ca • *The Canadian Triage and Acuity Scale (CTAS) is a method used by emergency services to indicate severity of presenting signs and symptoms • CTAS 1: severely ill, requires resuscitation • CTAS 2: requires emergent care and rapid medical intervention • CTAS 3: requires urgent care • CTAS 4: requires less-urgent care • CTAS 5: requires non-urgent care