Anticipatory Long-term care Electronic Resident Triage Tool (ALERT) for Canadian Long-Term Care Homes

This project aimed to develop a triage tool for long-term care homes (LTCHs), similar to e-INTERACT in the United States, to proactively identify residents at risk of transfer to emergency departments (ED) and/or death in the GTA, with potential for spread across Canada.

Possible Research Results

Anticipated findings: We anticipate we will develop a triage tool based on e-INTERACT for LTCHs in the Greater Toronto Area (GTA) with potential for spread across Canada.

Impact of findingsPointClickCare’s extensive involvement in Canada’s LTCH electronic health record market will facilitate spread of ALERT system-wide across the country. If successful, it is expected to set the standard in early identification and prompting of LTCH staff to review care plans proactively, thereby reducing potentially avoidable hospitalizations (PAHs). Development of such an IT solution for Canadian LTCHs is expected to transform frontline staff’s documentation and communication practices. Coupled with education on palliative care, this is expected to promote proactive individualized care plan reviews and enhanced in-house care, which has been proven to reduce PAHs.

About the Project

Seniors hospitalized for non-life-threatening conditions are at higher risk of confusion, complications and death compared to elders treated at home. Potentially avoidable hospitalizations (PAH) may occur if LTCHs staff do not identify early warning signs of illness, missing opportunities to modify care plans before residents are in crisis.

Project Team

Principal Investigator:

Michelle Grinman, MD, FRCPC, MPH — University of Calgary


Greta Cummings, RN, PhD, FCAHS, FAAN — University of Alberta

Tracey Human, RN, CHPCN(C) — Palliative Pain & Symptom Management Consultation/Toronto Service (PPSMC)

Aynharan Sinnarajah, MD, MPH, CCFP — Alberta Health Services/University of Calgary

Hannah Wong, PhD — School of Health Policy and Management, York University

Robert Wu, MD, MSc — University Health Network

Irene Ying, MD, MHSc, CCFP — Sunnybrook Health Sciences Centre

Knowledge Users and Partners:

Stuart Feldman — PointClickCare

Daile Moffat, RN, MBA — Sienna Senior Living

Project Contact: Dr. Michelle Grinman —

CAT 2015-40

Key words: long-term care; potentially avoidable hospitalizations; trigger tool; end-of-life

Rationale, Hypothesis, Objectives & Research Plan

Rationale: In the United States, e-INTERACT v4 embedded in PointClickCare’s platform proactively identifies residents at risk of transfer to ED and/or death, showing reductions in potentially avoidable hospitalizations (PAHs). However, there is no such tool validated in Canada, and e-INTERACT cannot yet predict when a resident will approach end-of-life.

Hypothesis: (1) Implementation of e-INTERACT will result in improved identification of residents at risk of health status decline, facilitating proactive care planning, contributing to a reduction in PAHs in three pilot LTCHs. (2) The additional triage component will predict whether a resident will die within one week or three months.

Objectives: (1) Determine the sensitivity and specificity of ALERT in identifying residents in three Greater Toronto Area (GTA) LTCHs at risk of ED transfer and/or death within three months. (2) Determine whether ALERT reduces potentially avoidable hospitalizations. 3) Test an additional program feature to predict residents at risk of imminent (days to one week) versus short-term (three months) death.

Research plan: We will adapt and evaluate the e-INTERACT v4 tool in three pilot Toronto LTCHs, comparing ED transfers and hospital deaths before/after program implementation. We will develop an additional feature to predict whether residents are entering EOL within one week (allowing a variation of three days) versus three months (allowing a variation of 30 days).