The Southwest Community Care Access Centre developed and implemented a new service delivery model to enable effective care for clients and families requiring “around the clock” monitoring (mainly pediatric and palliative care populations) in a cost efficient way. This new model, E-Shift, places PSWs at the bedside who are linked to a delegating nurse in a different location using real-time technology. Specially trained PSWs observe and report signs and symptoms using a smart-phone application connected to a secure portal monitored by the nurse. Working within regulations, the nurse monitors and delegates appropriate interventions in real time, ensuring safety and enhancing the quality of the care. E-Shift is not a technology solution; rather it is a new service delivery model that allows effective care for the client and appropriate supports for families in a cost efficient way without putting additional strain on the human resources system. E-Shift is now evaluated on a monthly basis through use of a report that was developed by a collaborative team of CCAC provider agencies, the technology provider, and external partners (e.g., UWO, pain and symptom management consultants). Interviews and focus groups are also conducted with clients and staff to further evaluate the program. Objective – To facilitate the opportunity for more clients to die in their own home as per their wishes Outcome – 100% of clients admitted to eShift expressed wish to remain at home to die; 84.6% achieved this goal. Objective – To decrease the number of visits to the ER in the last weeks of life Outcome – 92.3% of clients did not have an ER visit in the last weeks of life compared to 44% of EOL clients cited in research (Seow, H. [2009]. Ontario End of Life Homecare Patients) Objective – To decrease hospital admissions related to poorly managed symptoms in the last weeks of life Outcome – 15.4 % of required hospital admission related to poorly managed symptoms compared to 32% found in the quality of death study Objective – To decrease hospital admissions in the last weeks of life related to caregiver burnout Outcome – 92.3% caregivers claimed to not experience caregiver burnout with eShift in place (self-reported by caregivers) Objective – To enable discharge from hospital where there is insufficient informal caregiver support in the client’s home Outcome – 30.8% of clients could most probably not have been able to be cared for at home during their end of life without the support of eShift

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