Alison Corcoran, Advanced Practice Leader – Nursing
Maya Hohmann, Research Associate – Program Evaluation Unit
Angela Uy, Advanced Practice Leader - Nursing
Baycrest Health Sciences
June 5, 2014

• Background
• Capacity building at Baycrest
 INTERACT ®
 Clinical Skills Day
• Program evaluation
• Lessons learned

Use your clickers!
According to studies in Canada, what percentage of ED visits by LTC residents are potentially preventable?
A. 10% – 15%
B. 3% – 6%
C. 25% – 55%
D. 65% – 72%
10
%
– 1
5%
0% 0%
3%
–
6%
0%
25
%
– 5
5%
0%
65
%
– 7
2%

Use your clickers!
ED visits is a priority indicator for the
Ministry of Health and Long Term Care
Quality Improvement Program (QIP)
A. True
B. False
Tr ue
0% 0%
Fa lse

• Seniors higher frequency of use
- 60,509 ED visits over 12 months
• Potentially preventable transfers
- 25% - 55%
• MOHLTC QIP 2014-2015
ED transfer rate a priority indicator
- Considerations for future: preventable reasons for transfer

• Elevated costs
$260/ED visit
$545/ACSC visit ($386/senior ED visit)
• Quality of life
Iatrogenic illness
Loss of functional ability
Stress and anxiety

Improve the identification, communication, and management of acute changes in condition in LTC.
1. INTERACT® tools
2. Build capacity of staff
3. Monitor and evaluate our outcomes

Use your clickers!
What is INTERACT®?
A. Banking system
B. Online dating service for nurses
C. A quality improvement program to minimize aggressive interactions
D. A quality improvement program to reduce ED transfers
0% 0%
A.
B.
0%
C.
0%
D.

®
Inte rventions to R educe A cute C are
T ransfers (INTERACT ® )
Quality improvement program to reduce ED
Transfers from LTC
• Advance Care Planning tools
• Decision support tools
• Communication tools (Stop and Watch, SBAR)
• Quality improvement tools
Ouslander, J., et al. JAGS 2011

Use your clickers!
What are some common potentially preventable reasons for transfer to the ED?
A. Pneumonia
B. UTI
C. Dehydration
D. Conjunctivitis
E. Answers a, b, and c
Pn eu mo ni a
0% 0% 0% 0% 0%
UT
I
Deh yd ra tio n
Co nj un cti vit is
An sw er s a
, b
, a nd
c

Building capacity at Clinical Skills Day
Clinical Skills Day (CSD) – an annual, full day clinical education program for registered nursing staff.
• Interactive curriculum based on the
INTERACT® program and Best Practices
• Enhance capacity in assessing and managing most common reasons for
potentially preventable transfers to acute

• Scope of INTERACT® components
 SBAR
 Introduction to Stop and Watch
 Introduction to Care Paths
• ResponseCard © Technology
 TurningPoint 5
• Case studies, physical assessment skills, discussion

Attended Did not attend

50
40
30
20
10
0
100
90
80
70
60
68,9
92,6
76,2
90,4
76,7
96,4
77,0
95,7
Oct. 30, 2013 Nov. 6, 2013 Nov. 27, 2013 Feb. 26, 2014
Clinical Skills Day Session
Pre-Test
Post-Test

100
90
80
70
60
50
40
30
20
10
0
91,1
96,5
91,2
89,2
98,6
93,7 92,4
97,2
Oct. 30, 2013 Nov. 6, 2013 Nov. 27, 2013 Feb. 26, 2014
Clinical Skills Day Session
RN
RPN

CSD Session
2
Question
Info to include in SBAR
“Situation”
3
Signs/symptoms of dehydration
4
5
--
Signs/symptoms of pneumonia
% INCORRECT RESPONSES
PRE-TEST
Question not included
POST-TEST
19.2%
30.9% 26.4%
--
20.0%
--
21.4%

• Accessing INTERACT®
- http://www.interact2.net/
• Evaluation
- Technology vs. paper
• Integrate education into existing offerings
• ED Transfers as an organizational priority

Use your clickers!
According to studies in Canada, what percentage of ED visits by LTC residents are potentially preventable?
A. 10% – 15%
B. 3% – 6%
C. 25% – 55%
D. 65% – 72%
10
%
– 1
5%
0% 0%
3%
–
6%
0%
25
%
– 5
5%
0%
65
%
– 7
2%

Use your clickers!
ED visits is a priority indicator for the
Ministry of Health and Long Term Care
Quality Improvement Program (QIP)
A. True
B. False
Tr ue
0% 0%
Fa lse

Use your clickers!
What is INTERACT®?
A. Banking system
B. Online dating service for nurses
C. A quality improvement program to minimize aggressive interactions
D. A quality improvement program to reduce ED transfers 0% 0%
A.
B.
0%
C.
0%
D.

Use your clickers!
What are some common potentially preventable reasons for transfer to the ED?
A. Pneumonia
B. UTI
C. Dehydration
D. Conjunctivitis
E. Answers a, b, and c
Pn eu mo ni a
0% 0% 0% 0% 0%
UT
I
Deh yd ra tio n
Co nj un cti vit is
An sw er s a
, b
, a nd
c

Contact information
Alison Anne Corcoran RN, BScN, MN
Advanced Practice Leader – Nurse
Baycrest
Phone: (416) 785-2500 Extension 3826 acorcoran@Baycrest.org
Maya Hohmann
MA
Research Associate
Baycrest
Phone: (416) 785-2500 Extension 3319 mhohmann@baycrest.org
Angela Uy RN, MN, GNC(C)
Quality Partner
Baycrest
Phone: (416) 785-2500 Extension 3039 auy@baycrest.org