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BMJ Quality Improvement Report
London Transfer Project: improving handover documentation from long-term care homes to hospital emergency departments
  1. Joseph Carson1,2,
  2. Stephanie Gottheil1,
  3. Alan Gob1,
  4. Sherri Lawson1
  1. 1Department of Medicine, London Health Sciences Centre, London, Ontario, Canada
  2. 2Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Joseph Carson; joseph.carson{at}mail.utoronto.ca

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.

  • communication
  • emergency department
  • nursing homes
  • quality improvement
  • transitions in care

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjoq-2017-000024

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    Footnotes

    • Contributors JC was involved in building organisational partnerships, study design, data collection, change implementation, analysis and writing. SG was involved in study design, data analysis and writing. AG and SL provided mentorship on research design and project oversight.

    • Competing interests None declared.

    • Patient consent This study involved 11 organisations with independent research ethics policies. The organisations, represented by their executive directors, were asked for written voluntary consent to participate in the study. JRC also signed a confidentiality agreement with each LTC home, since he was exposed to patient information at LTC homes during staff training.

    • Ethics approval Ethical consideration at LHSC was provided by the Western University Health Sciences REB. The study was exempt from full board review since it was considered ‘quality improvement activity’ under TCPS Article 2.5.

    • Provenance and peer review Not commissioned; externally peer reviewed.