Module 2: Direct Comprehensive Primary Care in the LTC Setting
37 2.4.5 ED Diversion
- Hospitalization rates are 65% higher for seniors with dementia than for those without dementia
- More than 340,000 seniors at risk of frailty are admitted to hospital yearly
- Of these seniors, 2x are more likely to die within 1yr of discharge
Common conditions for LTC ED visits:
- Need for emergent diagnostic imaging and laboratory date to guide treatment
- Congestive heart failure exacerbation
- Infectious causes
- Falls
- Gastrointestinal Concerns[1][2][3]
Optional Reading
What can be done to prevent ED transfer and admission?
- Improved communication surrounding goals
- Goes beyond FULL Code/DNR
- Should be reassessed regularly, reflective of prognosis and priority should be to limit/avoid harm
- Educating families/residents
- Educate re. benefits vs. risks of hospital transfer so that families/residents have confidence in the level of treatment within LTC
- Routine rounding – guided by primary staff
- Allows capturing of changes early to prevent decline
- Working with community partners
- Nurse Practitioner Led Outreach Team
- Home and Community Care
- Analyze data
- Determine the main conditions requiring ED transfer and implement strategies to manage[4]