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Hospital and McMaster family medicine work to prioritize patient’s wishes in long-term care

August 6, 2019 — Every day in Ontario, long-term care residents are at risk of receiving unwanted and non-beneficial treatment because of errors related to consent.

Now McMaster University’s Department of Family Medicine and the William Osler Health System (WOHS) are teaming together on a project to reduce the number of long-term care patients in Ontario who, because of these errors, are transferred back and forth to hospital multiple times before they die.

In some cases, family members are asked to provide consent for treatment when the person is completely capable of making their own health-care decisions.  Other times, when the person is no longer capable, there are errors in identifying the right substitute decision maker, and in ensuring that the resident’s wishes, values, and beliefs for care are appropriately documented and considered.

The project was developed at the WOHS of Brampton and North Etobicoke in 2013 by health-care ethicists Jill Oliver and Paula Chidwick, and dubbed the Prevention of Error-Based Transfers (PoET).

Photos of Jill Oliver and Paula Chidwick

While working with local long-term care homes to change decision making they found that the number of residents who were transferred back and forth to hospital in the two months before dying there was reduced by 59 percent.

Health Canada has now provided $1.5 million for the WOHS to work with the Department of Family Medicine at McMaster University’s Michael G. DeGroote School of Medicine to further roll-out the project in southwestern Ontario over the next three years.

“This partnership is an exciting opportunity to not only increase PoET’s provincial impact, but to also promote a widespread culture shift in long-term care that has the potential to improve care for many in Ontario,” said Henry Siu, McMaster lead for the project. He is an assistant professor of family medicine at McMaster and a Hamilton long-term care and family physician.

He will lead the evaluation of PoET’s ability to reduce unnecessary emergency department visits with Pamela Forsyth, managing director of the Department of Family Medicine’s research enterprise.  This evaluation will also highlight key facilitators and barriers to implementing large scale innovations in long-term care; and investigate and report on the potential cost-savings to the healthcare system overall.

“We all deserve to live out our lives in comfort and dignity, with care that is appropriate to our wishes and values. I am pleased to support this innovative project that will help improve end-of-life care in Ontario,” said federal Minister of Health, Ginette Petitpas Taylor.

For more information on PoET, visit www.poetproject.ca

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