PRP148: Quality Improvement in long-term care: The PoET (Prevention of Error-Based Transfers) Southwest Spread Project (PSSP)

Henry Siu, MD; Jill Oliver, PhD; Paula Chidwick, PhD; Pamela Forsyth, MHSc RD; Nipa Chauhan; Theresa Nitti; Dawn Elston, MA; Erin Beaulieu, MPH, RD; Abe Hafid, MPH


Context In Ontario, long-term care (LTC) home residents are at risk of repeated transfers to hospital prior to death for unwanted or non-beneficial treatments. One major driver for these transfers is the “level of care” form, which is not aligned with Ontario’s Health Care Consent Act and results in consent-based errors during healthcare decision-making. Objective The Prevention of Error-Based Transfers (PoET) is a quality improvement project with two aims: 1) to align healthcare treatment with LTC resident wishes, values and beliefs, and 2) to avoid repeated hospital transfers resulting from consent-based errors, especially prior to death. Study Design PSSP uses a mixed method design including a retrospective chart review, as well as focus groups and stakeholder engagement surveys. Setting LTC homes in 2 Southern Ontario LHINs. Population LTC residents, substitute decision makers and staff will be invited to participate. Intervention Two PoET Spread Leaders observe LTC home activities for one month and recommend consent-related change ideas to staff. Main outcome measures Process and outcome measures are collected from participating LTC homes. Survey results are interpreted using Normalization Process Theory (NPT) designed to evaluate complex healthcare interventions. Results LTC home residents (N=580) had a mean age of 83.8 (SD 11.0), 68.4% were female, 54.8% were widowed, and 64.8% spoke English. Residents had an average of 5.2 (SD 3.4) active chronic illnesses. Preliminary survey results suggest strong staff engagement with PSSP. Anticipated Outcomes Reduction in the rate of emergency room transfers within the last 60 days of life will be reported. Focus groups will provide descriptive themes related to the facilitators and barriers to implementation success, and to LTC resident and clinician experience with PoET in LTC homes.

Social Media


11400 Tomahawk Creek Parkway
Leawood, KS 66211