Nurse Practitioner program helps keep seniors out of emergency department

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A new program to reduce transfers from Long Term Care (LTC) facilities to The Scarborough Hospital emergency department (ED) is having a positive impact on patient care and helping to reduce wait times.

Called the Central East LHIN NP LTC Outreach Team, the program employs Nurse Practitioners (NPs) to provide care to residents in LTCs for whom a transfer to an emergency department is likely. Its primary goal is to provide seniors with “the right care, at the right time, in the right place” and “by the right health-care provider.”

NPs Shirin Vellani and Katie Adams make up the CE LHIN NP Outreach Team based at The Scarborough Hospital. They work in the LTCs, assisting staff to provide emergency or complex medical care right in the nursing home.

“The key is to build the staff’s capacity skills, so they can recognize early on any change in a resident’s condition and call the NP in earlier,” Katie explains. “The NP can assess what’s going on, develop a care strategy at that time and ultimately, keep the resident out of hospital emergency.”

After the first ten weeks of the program, 60 per cent of the 106 encounters were averted from the emergency department, and 40 per cent received preventative care at the LTC. Only five of the 106 encounters were sent to the emergency department for treatment that could not be provided in the LTC.

Common medical issues that NPs would be called for include:

• Breathing concerns, dehydration, urinary issues;

• Signs and symptoms of infection;

• Behavioural changes;

• Pain and palliative care; and

• Falls assessment, suturing, skin tears, wounds.

“I think we’re making a huge difference to a lot of people,” Shirin says. “Diverting admissions to ED, increasing capacity of the nursing home staff, and connecting the LTC to the hospital – these are massive goals. But it’s the little things I see every day, helping families make the right decisions about their loved ones, that make me feel good about what I do.”

One of the LTCs Shirin works out of is Trilogy LTC Residence in Scarborough where Helen Kostka’s 81-year old husband Wal is a resident. For Helen, the NP Outreach Team is a “fantastic system. It’s the way to go.”

“Since Christmas, there were a couple of incidents where my husband might have been sent to the Emerg. But Shirin was able to look after his needs right at Trilogy,” Helen says. “I’m happy he’s not going in and out of the hospital. Shirin is very bright, educated and in touch with the doctor. She has been very helpful to me.”

Trilogy Administrator Marva Griffiths says Helen’s experience is not unusual, having noticed “fewer transfers from Trilogy to the ED.”

“It has helped family members tremendously to know that their loved ones are being treated right here and are not being unnecessarily admitted to ED,” Marva explains. “It has been a great education and training opportunity for our staff who feel they can reach out to Shirin for advice.”

While there are several NP Outreach Teams throughout Ontario, Katie and Shirin provide a unique service.

“Providing emergency care in the nursing home rather than in an emergency department is a great idea that really works,” says Dr. David Ryan, Regional Geriatric Program of Toronto. “This is another great service for seniors in the CELHIN.”

A similar program in Toronto has demonstrated a 25 per cent decrease in ambulance calls to homes with LTC Outreach service as compared to baseline, a statistic that also pleases Toronto EMS as it frees up paramedics for other emergency calls.

“The main benefit is that the care provided at the facility by the NP is considered to be the best care to meet the emergency medical needs of our patients in the most timely and effective way,” says Arthur Graham, Manager EMS Education. “If the medical needs can be taken care of without needlessly uprooting the patient from their home, that is the best possible outcome for everyone – the patient, their family, the emergency room, the long term care facility and EMS.”