Abstract
Objectives
To investigate the association between rapid access to radiographs, blood tests, urine
cultures, and intravenous (IV) therapy in a long-term care (LTC) home with resident
transfers to the emergency department (ED).
Design
Retrospective cohort study.
Setting and Participants
21,811 residents living in 162 LTC homes in Ontario, Canada.
Methods
We administered a survey to LTC homes to collect wait times for radiographs, basic
blood tests, urine culture, and IV therapy. Rapid availability was defined as typically
receiving test results within 1 or 2 days, or same-day IV therapy. We linked the survey
results to administrative data and defined a cohort of residents living in survey-respondent
homes between January and May 2017. We followed residents in the linked administrative
databases for 6 months, until discharge, or death. Two physicians identified diagnostic
codes for ED visits that were potentially preventable with rapid availability of each
of the 4 resources. Multilevel logistic regression models estimated associations between
potentially preventable ED visits and rapid diagnostic tests and intravenous access
while controlling for demographic characteristics, illness severity, LTC home size,
chain status, and physician availability.
Results
Rapid blood tests, radiographs, urine culture, and IV therapy were available in 55%,
47%, 34%, and 45% of LTC homes, respectively. LTC homes that were part of multihome
chains were less likely to have rapid access to the 4 resources. Of the 4736 residents
(27%) who visited an ED during follow-up, individuals from homes with rapid access
to radiographs (odds ratio 0.79, 95% confidence interval 0.66-0.97), urine culture
(0.88, 0.72-1.08), blood tests (0.83, 0.69-1.00), and IV therapy (0.93, 0.70-1.23)
tended to have fewer potentially preventable ED visits.
Conclusions and Implications
Rapid access to diagnostic testing and IV therapy in LTC reduced ED visits. Improving
access to these resources may prevent ED visits and allow residents to stay home.
Keywords
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Article info
Publication history
Published online: December 03, 2020
Footnotes
This study was conducted with financial support from the Ontario Ministry of Health and Long-Term Care Health Systems Research Fund Program Award for the QUality for Individuals who require Long-Term support (QUILT) Network (grant 255) and in collaboration with the Ontario Centres for Learning, Research and Innovation in Long-term Care hosted at Bruyère. This study was also supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care. The views expressed here do not necessarily represent those of the MOHLTC or the Ontario government.
The authors declare no conflicts of interest.
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