CFHI is not proceeding with the Strengthening our Long Term Care, Together: PREVIEW-ED© Spread Collaborative announced in the Spring of 2018. Teams who applied to participate in the Collaborative were invited to join CFHI’s Embedding Palliative Approaches to Care (EPAC) Spread Collaborative.

CFHI is currently in the process of developing its 2019-20 workplan which will outline future programming opportunities.

For more information about the tool, visit:


PREVIEW-ED© is an innovative screening tool, developed by Marilyn El Bestawi through CFHI’s Executive Training program: EXTRA. The tool helps staff in long-term care (LTC) detect early health decline among residents related to four conditions: pneumonia, urinary tract infections (UTI), dehydration and congestive heart failure (CHF). It measures the signs, symptoms and severity of nine indicators using a simple scale that allows the users to score each indicator and generate an aggregate score to quantify the change. The one-page tool takes between 8-15 seconds to administer per resident by Personal Support Workers or Care Aides as part of their regular duties.

The tool was piloted in a sample of long-term care homes in Toronto in 2012 and in Fraser Health in 2016-2017, and contributed to a significant reduction of ED transfer rates.

Fraser and Interior Health PREVIEW-ED© Spread Collaborative

The proportion of Canadians 65 and older is growing faster than any other age group. By 2031 Canadian seniors will account for 22.8% of the population. Seniors living in long term care have a high risk of being admitted to hospital. A 2014 CIHI report showed that about one in three emergency department (ED) visits among seniors living in long term care (LTC) is potentially avoidable. 1 Studies of the elderly admitted to hospital report 22.9% to 43.9% experience one or more iatrogenic illnesses* with potential for serious or fatal complications.2 The most common reasons for these avoidable visits are urinary tract infections, pneumonia and falls. These conditions could be managed at the facility, by direct care staff, to avoid an ED visit altogether. 3

The Canadian Foundation for Healthcare Improvement (CFHI) has developed a partnership with Fraser Health and Interior Health focused on spreading the Practical Routine, Elder Variants Indicate Early Warning for ED (PREVIEW-ED©) tool to residential homes in the Fraser Health and Interior Health regions of British Columbia.

Forty residential care homes across Fraser Health and three homes in Interior Health are participating in the first phase of the PREVIEW-ED© Spread Collaborative, where the tool is being rolled-out and used daily.  The second phase roll-out of PREVIEW-ED© will take place in 2017/18 across remaining residential care homes in both regions.

Learn more about the Fraser and Interior Health PREVIEW-ED© Spread Collaborative »

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

1Canadian Institute for Health Informatics (CIHI). (November 2014). Sources of Potentially Avoidable Emergency Department Visits. Retrieved from
2 Jensen PM, Fraser F, Shankardass K, Epstein R, Khera J. Are long-term care residents referred appropriately to hospital emergency departments? Can Fam Physician 2009 May;55(5):500-505.
Walker JD, Teare GF, Hogan DB, Lewis S, Maxwell CJ. Identifying potentially avoidable hospital admissions from Canadian long-term care facilities. Med Care 2009;47(2):250-254.