As the coordinator and clinical lead for the Waterloo Wellington Nurse-Led Outreach Team (NLOT), Carrie Heer, NP, provides acute and episodic care to residents at two long-term care (LTC) homes, working collaboratively with physicians and building nursing capacity to reduce avoidable emergency department (ED) transfers and hospital admissions. Carrie leads a team of nurse consultants to support resident-centred care, implement best practices and optimize ED avoidance strategies. Under Carrie’s leadership, her NLOT team has consistently achieved the lowest ED transfer rate of all LTC homes in the province over the last 5 years. Carrie is also the provincial lead of the NLOT Committee and volunteers as a committee chair at the College of Nurses of Ontario. In her spare time, Carrie is an avid world traveler and retail therapy expert.
Virtual care in Ontario long-term care and retirement homes: An innovative response to COVID-19
Presenter: Carrie Heer, St. Joseph’s Health Centre, Guelph, Canada
Objectives: To improve resident’s access to care and quality of care during COVID-19 in long-term care (LTC) and retirement homes using virtual care.
Design: The Model for Improvement (Plan-Do-Study-Act [PDSA]) guided the implementation and evaluation of virtual care each home. Participating homes received a free computer tablet, platform training, biweekly webinars, online toolkit resources and weekly support from a designated nurse consultant and/or nurse practitioner.
Setting and Participants: A representative sample of 10 LTC and 10 retirement homes were recruited from one regional health authority for a 3-month PDSA. Selection criteria included having a working Wi-Fi connection as well as support from their medical director or attending physicians and executive leadership. All agreed to restrict use of virtual care to the two platforms selected.
Methods: A pre-post test survey was conducted to determine if homes had appropriate hardware, reliable Wi-Fi and provided virtual care in their home. Project manager met weekly with each of the nurse consultants to ensure the study plan was being followed, conducted midpoint interviews with home leadership and conducted multiple focus groups and interviews with residents, family members, staff and medical doctor (MD)/NPs. Nurse consultants conducted readiness assessments and compared their results to use-data to determine the relationship between readiness and use of virtual care, and to address any gaps in readiness identified.
Results: Homes with the highest readiness scores had the highest use of virtual care and homes with the highest use of virtual care had lower emergency department transfers and hospitalizations than homes with lower use of virtual care. Physician engagement, home-level factors and models for sustaining virtual care in the home impacted use of virtual care the most. Overall, long-term care homes were much more “ready” than retirement homes to use virtual care.
Conclusions and Implications: Homes should be encouraged to adapt virtual care when readiness factors are high in order to maximize related benefits to residents, staff and the community.