Eldercare Access Strategy in Emergency Rooms (easier+)

The Eldercare Access Strategy in Emergency Rooms (easier+) project was funded by the Ministry of Health and Long-Term Care was an evidence-based strategy developed to alleviate pressures within Emergency Rooms (ER) at Quinte Health Care - Belleville General Hospital and Kingston General Hospital. It included an integrated, multi-component strategy providing effective client-centred care to the high risk, frail elderly accessing the ER in South East Ontario. The objective was to respond to three targeted priorities: 

• Improve service through enhanced communication & collaboration
• Enhanced ER capacity
• Improved outcomes

Components of the easier+ strategy included:

• Introduction of the Triage Risk Screening Tool (TRST), an evidence-based assessment tool, designed to identify and
  flag frailty in individuals 75 or older in the ER setting.
• Development of a streamlined method of accessing enhanced services via Community Support Services (CSS) &
  Community Care Access Centre (CCAC)
• Promote identification of high-risk profile through enhanced communication with primary care
• Education and Training of staff in CSS, CCAC and ER to increase system capacity to identify and respond to
  eldercare issues

The project became a catalyst for local health care providers to reflect on their eldercare practices and identify existing gaps in knowledge, attitudes and skills. A second phase of the project (Hospital Eldercare Clinical Education) focused on enhancing knowledge and skills for 27 potential champions in eldercare working within associated acute care hospitals. The goals were twofold: to create a sustainable training model for the easier+ strategy and to support ongoing organizational staff development in care of the frail elderly.


OUTCOMES

  • The implementation of an evidence-based screening process for frailty in individuals 75 or older was successful at the 2 pilot sites
  • A sustainable strategy of flagging potential clients of CSS and CCAC was introduced and continues to date
  • New and ongoing collaborative processes between all participants around the care of the frail elderly
  • Supported a cadre of clinicians in developing enhanced eldercare assessment and management skills as well as becoming leaders in future quality improvement strategies

PROJECT PARTNERS

  • Community Support Services
  • Kingston General Hospital
  • Quinte Health Care - Belleville General Hospital
  • South East Community Care Access Centre

KNOWLEDGE MOBILIZATION ACTIVITIES

Knowledge-to-Practice Workshops

  • easier+ November 2007 Workshop: CCAC Geriatric Assessor Education Program - a Five-day Workshop covered the following topics: epidemiology; physiology; hearing loss; chronic illness; geriatric giants; geriatric assessment; mental health in the elderly; pain; polypharmacy; mobility; community support services & geriatric emergency care
  • easier+ February-May 2008 Workshop - Five days of didactic education including case-based learning, three days of practical placement opportunities and 20 days of mentoring in Emergency Room settings

Knowledge-to-Practice Activities

  • Hospital Eldercare Clinical Education (2009): Core Program- Three day core curriculum included: epidemiology & physiology of aging; holistic identification of unmet needs; proactive care; common geriatric issues and navigation of healthcare services
  • Hospital Eldercare Clinical Education (2009): Advanced Program - One day curriculum focused upon managing the complex mood and cognition issues in the hospital setting
  • Hospital Eldercare Clinical Education (2009): Mentor Program - Three day curriculum to deliver effective education training around eldercare issues transferable to the hospital work environment

Presentations

  • Puxty, J., (2008).  Implementing easier+ in SE Ontario. 3rd Annual Quality Healthcare Network Spring Symposium, King City, ON. May 2.
  • Puxty, J., (2008).  Implementing easier+ in SE Ontario. National Healthcare Leadership Conference, Saskatoon, SK. June 3.
  • Puxty, J., (2008).  Evaluating easier+ in SE Ontario. NICE Annual Knowledge Exchange, Toronto, ON. June 6.
  • Robb Blendermann, L., Puxty, J., (2008).  Implementing easier+ in SE Ontario. 7th International Elder Care – Older People Deserve the Best! Registered Nurses’ Association of Ontario Conference, Markham, ON. September 26.

Publications

  • Robb Blendermann, L., et al., (2008).  Geriatric Nursing: Building Knowledge with Mentoring. Nursing Research Conference, Nursing Research Council of Southeastern Ontario Health Sciences Centre, Kingston, ON. Poster. June 6.
  • easier+: The Project.Kingston Life Magazine. Article. September/October 2008 Issue.