PREVIEW-ED© Spread Collaborative

No one looks forward to a trip to the hospital. A preventable trip to the hospital is even more unappealing.

Thankfully, Fraser Health in British Columbia is working with CFHI to curb preventable trips to the emergency department (ED) among seniors living in residential care with the PREVIEW-ED© Spread Collaborative.

Fraser Health, one of five health authorities in B.C. that deals with regional programs and services, is spreading a tool to prevent ED transfers for residents in all 80 of their residential care homes.

The tool – called the Practical Routine Elder Variants Indicate Early Warning for ED, or PREVIEW-ED© for short –  was developed by former EXTRA fellow, Marilyn R. El Bestawi.

Don’t let the long name fool you though – the premise is simple: In 8-15 seconds, care aides and personal support workers can use the tool to measure nine indicators for four conditions (Urinary Tract Infections, Congestive Heart Failure, Pneumonia and Dehydration) and their related signs, symptoms and severity levels to identify early health decline.

“Fraser Health knows that transferring our frail elders to acute care often results in rapid deterioration, particularly for residents living with dementia,” said Catherine Kohm, Project Director, Residential Care Integration at Fraser Health.

Fraser Health became involved with PREVIEW-ED© when El Bestawi was looking for an area to pilot the tool.

“We had four homes that volunteered to trial the tool. The results were so positive that our CEO decided to proceed with spreading it to all of our 80 residential care homes,” said Kohm.

Fraser Health delivers a range of healthcare services to more than 1.8 million people living in communities like Burnaby, White Rock and Hope in B.C.

“Our residential care services are for adults who can no longer live safely or independently at home because of complex health care needs.”

Catherine Kohm

Catherine Kohm, Project Director, Residential Care Integration at Fraser Health

Providing the best quality of care to their residential clients is a key reason Fraser Health is collaborating with CFHI to spread PREVIEW-ED©.  

“Transferring to the emergency can be disorienting – waiting on a stretcher for long periods of time,” Kohm explained.

Hospital environments enable deconditioning in this particularly susceptible population, making it more likely that the resident’s health will decline further or be susceptible to iatrogenic* events.

The PREVIEW-ED© tool allows early detection, prior to the onset of pneumonia, urinary tract infections, congestive heart failure and dehydration allowing assessment and treatment of the resident onsite.

Out of Fraser’s 80 homes, over 90% have received education and are in various stages of implementation – and the results are already beginning to show.

“Our goal during the pilot project was to decrease the transfer rate to emergency by 25%, we ended up diverting 71% of transfers.”

Fraser Health also discovered that the tool allowed them to pick up on other issues, such as flu early warning signs.

Another side-effect was improved communication – “care aides now have a formal way of observing the residents on a daily and a way of formally communicating small changes to the registered staff.”             

Kohm says there is one anecdote that sticks out in her mind.

“One of our homes had a resident that did not score on the PREVIEW-ED© tool but the Care Aide did write a comment that the resident did not seem herself. The nurse contacted the resident’s daughter to inform her of the Care Aide’s observation.”

The resident was then visited by her daughter, who remained with her for two days while she was actively dying.

The communication enabled her to spend her mother’s remaining 48 hours together.

“Change is always challenging but the spread collaborative has shown us the importance of communication  and the resourcefulness of our staff. We appreciate the partnership we’ve developed with CFHI as we look forward to spread the tool,” said Kohm.

At the provider level, staff are involved in a variety of ways – through unit champions, colleague education, sharing success stories and improvement strategies.

The PREVIEW-ED© Spread Collaborative is being implemented in two phases with CFHI, Fraser Health and Interior Health working together to spread and evaluate the tool across the regions.

CFHI is providing educational webinars, online learning tools and support for in-person workshops and building in quality improvement capacity.

Kohm is confident in the future of the PREVIEW-ED© tool at Fraser Health.

“Our CEO is innovative and driven by the needs of the resident. We always ask does this process improve the patient experience?”

When it comes to PREVIEW-ED©, the answer is a resounding yes.

*when a patient acquires an illness or injury from services provided by a medical provider.