Long-term care residents in Thunder Bay are seeing the benefits of the nurse-led outreach (NLO) program. Funded by the North West LHIN and sponsored by the Thunder Bay Regional Health Sciences Centre, NLO is a program designed to bridge the gap between health-care service providers in nursing homes and those working in hospital emergency departments.
Established in August 2009, the team consists of Pamella Robinson, a registered nurse, Mary Jane Melita, a nurse practitioner, and Cathy Covino, director of quality and risk management.
The main objective of the program is to give residents the care they need in the comfort of their own homes - in this case, a nursing home. The NLO team provides care in-house, to reduce or eliminate the discomfort and anxiety of an unnecessary trip to the hospital. "We have been referred to as a travelling clinic. Nurse-led outreach is about increasing quality of life," said Covino.
The NLO team works with nursing home staff to provide Canadian Triage and Acuity Scale level 4 and 5 patient care. While doing rounds to provide wound and respiratory assessment and care, the team ensures that nursing home staff are aware of the signs and symptoms of infection, complications associated with enteral tube feeding and that they are properly trained to change wound dressings and reattach IV-antibiotics.
Nurse-led outreach team members can track trends and alert the Thunder Bay District Health Unit if they are seeing a lot of cases of pneumonia or a particular strain of the flu in different long-term care residences. The members of the team share that information and proper treatments with staff at each of the nursing homes they visit.
Referrals
Melita and Robinson draw on their professional experience to provide referrals for cognitive or swallowing assessments, linkages to community programs such as the Diabetes Network and the Community Outreach Team and to offer end-of-life and palliative care assistance.
"It's nice for the staff and families to be able to ask questions and find out what is available for their family member. It all boils down to the right time for the right care for the right person," said Melita.
In a city with nine nursing homes and 1,100 long-term care residents, integrating this health-care model is an ongoing process. The NLO team began by meeting with the medical directors and staff of all the long-term care residences in Thunder Bay to determine how best to proceed.
The first priority was adopting an effective communication process to ensure clear, consistent sharing of information between the nursing homes and the hospital. Standardized transfer sheets were developed to clearly outline patient health information. There is 100 per cent compliance among all nine long-term care residences, even though NLO is currently working with only five of the city's nursing homes.
"Over the past year, a mutual respect has developed among staff both in-house and on the nurse-led outreach team," said Tom Gash, administrator of Dawson Court, a long-term care facility, and chair of the nurse-led outreach program. "The program provides additional resources to the home that weren't necessarily available to us before. That support has proved to be quite beneficial in a number of instances. We are at the point now where we have been effective in achieving desired outcomes. The future is dependent on funding to fully maximize the potential."
Results
NLO has already surpassed the goals set by the NW LHIN for its three main deliverables. As of July 2010, they were tracking a 95.7 per cent reduction in the number of residents making unnecessary trips to the emergency department. Of those residents who did go to the ER, 90 per cent avoided admission when appropriate. In 51.7 per cent of the cases when they did spend time in the hospital, there was a decrease in the length of stay.
These numbers highlight the benefits of clear communication, information sharing and knowledge exchange. The true benefits are most evident among the residents.
"In the past, if you were a resident in long-term care, the homes would say, ‘When in doubt, send them out (to the hospital),'" said Covino. "Someone who needs an IV-antibiotic does not need to go to emerg. They can stay in their bed playing cards with another resident, and we go there. Instead of sitting in a loud, noisy emerg on a stretcher, they can go about their regular daily business. They can play bridge with their friends and eat their meals, even if their treatment is three or four times a day. They can get what they need right in their rooms."
