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, 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 by Personal Support Workers or Care Aides as part of their regular duties.

Care Aides and Personal Support Workers comprise more than 70 percent of the staffing in LTC homes and provide the majority of the direct care and are ideally positioned to notice the subtle nuances in the health status of a resident. If the resident’s condition is normal for them, the tool score is zero. If the score is greater than zero, a registered staff member is informed and intervenes as needed, guided by an escalation path included with the tool.

The PREVIEW-ED© tool is sensitive to four conditions:

  • Urinary tract infections (UTI)
  • Congestive Heart Failure (CHF)
  • Pneumonia
  • Dehydration

The PREVIEW-ED© tool helps:

  1. Reduce avoidable emergency department (ED) transfers and associated increased distress related to the four conditions
  2. Reduce the risk of iatrogenic* events
  3. Reduce deterioration of mobility and cognition in residents of residential care

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

The Facts

  • Referrals or admission to an ED or acute hospital can create discontinuity of care and pose threats to residents of residential care (RC), including distress, risk of iatrogenic events, and deterioration of mobility and cognition.  Hospital transfers also account for a high proportion of total healthcare costs. 
  • Visits to the ED have been associated with increased risk of new acute infections and a longer length of stay could further compound this risk. In addition, the long exposure to an unfamiliar environment may be distressing for older seniors, many of whom also suffer from cognitive impairment. More than half of the potentially avoidable visits involved patients age 85 and older.
  • Residents with dementia who are admitted to hospital do poorly. Up to half of those admitted develop acute confusion caused by delirium that is often unrecognized by doctors and nurses.  Delirium doubles an elderly patient's risk of dying within a year of hospitalization.345 
  • The PREVIEW-ED© Tool has been tested across four homes in Fraser Health, with 176 residents, and resulted in a 71% diversion from the ED for the four identified conditions.   

3 Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med 2008;168(1):27.
4  Leslie DL, Inouye SK. The importance of delirium: economic and societal costs. J Am Geriatr Soc 2011;59(s2):S241-S243.
5 Leslie DL, Zhang Y, Bogardus ST, Holford TR, Leo‐Summers LS, Inouye SK. Consequences of preventing delirium in hospitalized older adults on nursing home costs. J Am Geriatr Soc 2005;53(3):405-409.