The EXACT study: Examining the Transfer of Long Term Care Patients to the Emergency Department

Project lead

Professor Greta G. Cummings, Dean at the University of Alberta’s Faculty of Nursing

Greta Cummings: University of Alberta, Faculty of Nursing

In collaboration with the Brain Care Centre, the University of British Columbia, emergency medical personnel and continuing care managers, nurses, healthcare aides, physicians, and family council members from eight nursing home sites across Alberta.


Unnecessary transitions of frail elderly nursing home residents to the hospital emergency department are costly and can negatively impact the resident’s quality of care and quality of life. Often times, the decision to transfer a resident is complex and unclear. This study identified attributes of avoidable transitions and factors influencing decisions-to-transfer in ambiguous cases.

The purpose of the Examining Aged Care Transitions – Decision Making Guide (EXACT DMG) study was to pilot test a fast decision-making guide for nurses in the context of potentially avoidable transfers. This decision-making guide consists of two parts, a 5 minute assessment to determine the urgency of the residents change in condition, and an algorithm that encourages the nurse to consider all pertinent factors and weigh the risks and benefits of a transfer.

Project Summary

Interviews and focus groups with key informants from eight nursing homes and survey data from 26 nursing homes in the Edmonton region were used to develop a draft decision-making guide to help front line staff determine whether or not to transfer a resident to the emergency department. An animated video was also developed that illustrates the harmful effects avoidable transfers can have on seniors.


  1. The Decision-Making Guide (DMG) consists of a 5-minute clinical assessment to determine urgency of the change in condition and includes steps to help the nurse systematically gather information to determine if a transfer is in the residents’ best interest.
  2. An animated video to guide this process (product of the larger overall study that overarches EXACT – Older Persons’ Transitions in Care (OPTIC)).

IMPACT and Ultimate Success

Dr. Jude Spiers, University of Alberta, Faculty of Nursing – working on the Decision-Making Guide

The draft decision-making guide will be piloted for another year in several Edmonton sites for further development and adaptation in specific long term care contexts. The video, available below and on the Network website, promotes understanding and discussion about the importance of early detection and management of condition changes in residents to avoid unnecessary transfers.

Avoidable transfers is a major concern. Reducing the number of transfers can have a major effect on the wellbeing of LTC residents. Our research team is currently working with the College of Licensed Practical Nurses of Alberta to develop a communication workshop to enhance LPNS confidence and skills in working with families during transfers decisions, this kind of work needs to be expanded to all nurses working in LTC. A next logical step in this program is an exploration of the interactions with EMS and development of a strategy to improve transfer interactions.

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