Improving Care - Avoiding Hospitalization for Long-Term Care Residents

January 29, 2014
Noon – 1:00 pm ET


In Ontario, more than 75,000 people aged 65 and older currently live in long-term care (LTC) facilities.  During a six month period in 2005, 25 percent of LTC residents in Ontario visited an emergency department (ED) at least once. Nearly 25 percent of the initial visits were classified as potentially preventable and research indicates that up to 48 percent of hospital admissions of LTC residents are potentially preventable.

Marilyn R. El Bestawi, a senior healthcare executive with experience in geriatrics, hypothesized that the best way to avoid deterioration in health status among LTC residents was to avoid unnecessary hospitalizations in the first place. Through an Ontario-led approach to patient care, developed through CFHI's EXTRA Program for Healthcare Improvement, Ms. El Bestawi and her team reduced preventable ED visits among long-term care residents by 57 percent in just three months.   

If applied across the province, Marilyn El Bestawi's PREVIEWED-ED (Practical Routine Elder Variants Indicate Early Warning for ED) model could realize potential savings in the order of $6.2 million annually.


Join CFHI and guest speakers Marilyn El Bestawi, senior healthcare executive and Dr. Joy Richards, Vice President Health Professions and Chief Nursing Executive at University Health Network, for this session of On Call, where participants will hear about and discuss:

  • how to reduce preventable ED visits from long-term care
  • why this initiative was important to the University Health Network (UHN)
  • factors that have promoted successful implementation and sustainability of the PREVIEWED-ED™ model within a major health sciences centre
  • how this initiative is being spread at the organizational and provincial levels

Join the discussion!

Guest Speakers:

ElBestawiMarilyn El Bestawi is a Registered Nurse with a Masters’ degree in Health Administration. She is a Certified Health Executive with the Canadian College of Health Leaders and a Certified Long Term Care Administrator. Marilyn has recently completed her 2 year fellowship in the Canadian Foundation for Healthcare Improvement EXTRA Program.

Marilyn has worked in both community and teaching hospitals. Her positions in Health Care have spanned the range from staff nurse to senior management including a one year interim Chief Nursing Executive role.

Marilyn is currently working at University Health Network, in a contract position.

RichardsDr. Joy Richards is the Vice-President Health Professions and Chief Nursing Executive at University Health Network in Toronto, an academic health science centre comprised of four hospitals – Toronto General Hospital, The Princess Margaret Hospital, Toronto Western Hospital, and Toronto Rehab Institute. Joy is a Past-President of the Academy of Canadian Executive Nurses (ACEN) and holds clinical appointments at the University of Toronto, Bloomberg Faculty of Nursing, York University Faculty of Nursing, and Humber College.

Her previous experience includes progressive senior nursing management positions in the acute care and long-term care sectors; nursing education and nursing informatics and has presented her work, both nationally and internationally.  She has also published many articles and book chapters related to her professional work.

Dr. Richards graduated from the University of Toronto with a Bachelor of Science in Nursing in 1981, and a Master of Nursing in 2000. She then went on to complete a Master of Arts in Human and Organizational Systems from Fielding Graduate University in Santa Barbara California in spring of 2005.  Joy is also a graduate of the Queen’s University Executive Program and is a Johnson & Johnson Wharton Fellow, University of Pennsylvania.  She completed her PhD studies in 2008, in Human and Organizational Development at Fielding Graduate University: Her dissertation focused on exploring and understanding the development and practice of feminine courage in leadership.  She has also received numerous awards, including the 2010 Health Achieve Margret Comack Award of Excellence in Nursing Leadership and Sigma Theta Tau Award for Excellence in Nursing Administration.

Joy’s particular interests, focus and passion are in the area of clinical leadership, quality of work life environments and the development of client-centred practice settings, with a special focus on excellence in geriatric care.