Every day in Ontario, long-term care (LTC) residents are at risk of receiving unwanted and non-beneficial treatment because of errors related to consent. The PoET (Prevention of Error-based Transfers) Project aims to reduce these consent-related errors that contribute to transfers from long-term care to hospital by identifying opportunities to align care with the Health Care Consent Act so that residents receive treatment that is in line with their wishes, values and beliefs.
The project was developed as an Ethics Quality Improvement project at William Osler Health System (WOHS) in 2013. While working with local long-term care homes to change decision making, they found that the number of residents who were transferred back and forth to hospital in the two months before dying there was reduced by 59 per cent.
DFM led the evaluation, which measured the impact of PoET’s ability to reduce error-based transfers to hospital. The evaluation also highlighted key facilitators and barriers to implementing large-scale innovations in long-term care, and investigated and reported on the potential cost-savings to the health care system overall.
For the final phase of the PoET Southwest Spread project, we accessed health administrative data to compare resident transfers to acute care, repeat transfers at the end-of-life, and receipt of palliative care between PSSP homes and matched control homes. We also measured the cost-savings associated with transfers, repeat transfers at the end-of-life, and healthcare use of residents who live in PSSP homes compared with matched control homes. We also identified which health sector experienced the highest cost-savings comparatively.
The project was completed in 2023, and has resulted in two important publications in the Journal of the American Medical Directors Association (1, 2). Together, both publications indicate that LTC homes implementing PoET had: 1) a reduced transfer rate to acute care LTC residents (27% reduction), especially in the last 2 months of life (45% reduction); and 2) an increased rate of palliative care encounters with physicians by LTC residents (147% increase in palliative physician encounters). These findings show that aligning LTC home practices with the Healthcare Consent Act leads to positive patient-level and system-level impacts.
Program Lead
Henry Siu
MSc, MD, CCFP (COE), FCFP
Associate Professor
Medical Director, Stonechurch Family Health Centre
Program Team
Knowledge Translation Products
This project has been made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada.