William Osler Health System, in cooperation with participating long-term care homes in the Central West Local Health Integration Network (LHIN), recently completed an Ethics Quality Improvement Project with the goal of reducing errors related to consent, capacity, and substitute decision-making before long-term care residents are transferred to Osler's Emergency Department. We had learned through a previous project that many errors stemmed from the use of the level of care form, which can drive treatment decisions and transfers to the emergency department in ways not initially intended by the form.  With this project, we wanted to decrease these errors by removing the level of care form and improving the process around decision-making prior to transfer. This goal was largely achieved through LHIN-wide ethics support and education, including the use of a checklist to minimize errors, and a different form of documentation (called an “Individualized Summary”) in selected homes in the LHIN.

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