William Osler Health System

Many transfers to hospital are the result of errors related to consent, capacity, and substitute decision making. These errors profoundly affect not only treatment prior to death (from being made to undergo unwanted amputations just prior to death, to being tube fed despite wishes to forgo artificial nutrition), but also the location of death (for example, dying in an ambulance or ED instead of in one’s own bed). The Prevention of Error-based Transfers (PoET) Project was designed to reduce error-based transfers between Long-Term Care (LTC) to hospital.

To achieve the change William Osler Health System (Osler) collaborated with residents, staff and physicians in LTC Homes across the Central West LHIN to co-design and develop the “Individualized Summary” tool, replacing the Level of Care form that drives error-based transfers.

PoET’s objective is to prevent these error-based transfers by aligning the culture of decision-making with the wishes, values and beliefs of residents and the laws of Ontario. This approach helps to achieve basic ethical obligations when providing residents with wanted and beneficial treatment, and to refrain from imposing unwanted and potentially harmful treatment.

Aligning with these obligations improves quality of care for the resident, and promotes responsible stewardship of the system. Data has revealed that since Q1 of 2015-2016 there has been a shift in the number of LTC residents who die in hospital after repeated transfers, and a 56% reduction in the number of these transfers over 2012-2013.

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