Trans-ED-HC Project

The Problem

Older adults are using Emergency Departments (ED) at a rapidly increasing rate, and are at higher risk of post-discharge patient safety incidents and adverse outcomes. Home care clients make up a large percentage of frail community-dwelling older adults and are main users of the ED. There is still much to learn from patient safety incidents in this context. 

 The Question

The goal of this project was to describe key challenges in the ED to home care transition process among relevant care providers, staff, patients, and informal caregivers in order to inform policy and theory development.

 OUR Approach

To explore challenges in transitions, we specifically examined the prevalence of patient safety incidents among patients transitioning from EDs to home care. We conducted a retrospective cohort study using population level data on the transitions from the ED to home care in the Hamilton Niagara Haldimand Brant (HNHB) Local Health Integration Networks (LHIN) (Ontario) in the 2013/14 fiscal year.

A second arm of the project simultaneously recruited home care clients who had a recent ambulatory ED visit across three representative regions. In-depth, semi-structured interviews were conducted with home care clients and informal caregivers. Focus groups were held with care providers in each setting, incorporating ED physicians, nurses, and allied health, paramedicine, and home care staff.

 OUR Results

The rate of patient safety incidents is twice as high as for all home care patients, which is already higher than the general population. The main risks and priorities were falls, medication issues, or delirium. Many patient safety incidents were associated with adverse patient outcomes.

We presented qualitative themes through restorying, or combining elements of participants’ stories into fictional accounts that capture themes and incorporate real quotes while preserving anonymity. After conducting a capstone workshop with over 40 regional stakeholders and key Canadian informants, we combined restoried participant accounts with trends from secondary data analysis to compose ‘Tip Sheets’ about transitioning from the ED to home care. Versions of these fact sheets were tailored for both families, patients, and care provider staff.


 Our Team

Team Members

Graham Campbell, McMaster University

Lauren Crutchlow, Conestoga College

Kelsey Huson, Conestoga College

Dr. Jeff Poss, McMaster University

Linda Sheiban, Conestoga College

Cindy Wang, Conestoga College

Samantha Yang, Conestoga College

Team Leads

Principle Investigator – Dr. Andrew Costa, McMaster University

Co-Investigator – Dr. Veronique Boscart, Conestoga College

Co-Investigator – Mr. Martin Farrugia

Co-Investigator – Dr. George Heckman, University of Waterloo


Thanks to our partners, the HNHB LHIN ED Directors Committee, HNHB LHIN Emergency Service Steering Committee & HNHB LHIN Community Care Access Centre.



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