A study led by Sunnybrook Health Sciences Centre, Michael Garron Hospital, Humber River Health and the University of Toronto, in partnership with 20 long-term care (LTC) homes across Toronto, has found that on-site rapid testing for respiratory infections results in fewer transfers to the emergency department among LTC residents.
During the COVID-19 pandemic, gaps in infection prevention and control, along with delayed testing, led to devastating consequences for residents in LTC homes. Five years later, this new research has brought about transformative change in how residents are tested for seasonal respiratory viruses, enabling earlier detection and containment of outbreaks.
"The pandemic showed us that the current testing approach isn't meeting the needs of LTC residents who often await testing results for several days," says trial co-principal investigator Jerome Leis, medical director of infection prevention and control at Sunnybrook and an associate professor of medicine in U of T's Temerty Faculty of Medicine.
"Outcomes like hospitalization and death are directly linked to how quickly an outbreak is detected, but the good news is we can now do better in LTC homes than we did in the past."
Published in JAMA Internal Medicine , the PROMPT-LTC trial is the first of its kind. A desktop rapid testing instrument that can be operated by trained staff allowed LTC homes were able to identify positive cases of COVID-19, influenza and respiratory syncytial virus (RSV) in under an hour compared to the usual three-to-five-day turnaround when this testing relies on transporting specimens to an off-site laboratory.
The trial took place during the 2024-2025 respiratory virus season, during which half of the participating LTC homes used on-site rapid testing. The remaining LTC homes received standard testing that was sent off site. The researchers found that LTC homes with on-site rapid testing tested over twice as often, and residents were treated earlier with antiviral medication for the flu.
"When it takes multiple days to get a test result, the threshold for testing is limited to the sickest residents, making it harder to contain the spread of infection," says Leis. "This gap is addressed with on-site testing leading to better surveillance and case detection by LTC homes."
The improved detection of respiratory infection translated to better outcomes for residents, including an 11 per cent lower chance of being transferred to a hospital emergency department for complications of a respiratory infection.
Infection Prevention and Control teams from each hospital trained LTC home staff to integrate on-site rapid tests into their workflows, enhancing staff education and capacity building.
Baycrest was one of the LTC homes that received on-site rapid testing and led implementation of the intervention within the home.
"Working in close collaboration with our hospital partners was instrumental in allowing us to implement the intervention," says Lisa Marcovici, director, resident care and experience, Apotex Centre, Jewish Home for the Aged at Baycrest. "Our staff now have the confidence and skills to not only support with testing, but train and educate other staff, which allows us to build greater care capacity within the home."
Researchers concluded that the use of on-site rapid testing in LTC homes led to improved resident outcomes equivalent to four avoided emergency department visits per 100 beds throughout the respiratory virus season.
If this approach were used across Canada, the research team predicts that this could prevent 8,000 transfers to hospital emergency departments each year between November and March, when hospitals are often overcrowded with patients admitted with complications of respiratory infection.
"Bringing hospital-level testing into LTC homes is a major improvement in quality of care for residents and knowing that this approach improves resident outcomes and can free up health-care capacity should hopefully justify the upfront cost," says Leis.
Integration a key to success
The PROMPT-LTC trial is an example of how the Toronto Academic Health Sciences Network is leading health-care system transformation in collaboration with partners to improve access to care and adopt patient-centred approaches that improve outcomes for all.
"These relationships enhance our capacity to prevent and manage outbreaks, strengthen staff knowledge and confidence and help support timely and informed decision-making," says Marcovici. "Through this collaborative approach, we are better positioned to deliver the highest standard of care for our residents."
As the PROMPT-LTC trial demonstrates, investing in integrated models of care enables hospitals and community partners to better leverage their resources and expertise to address some of the health-care system's most complex issues.
"By working across the health-care sector and linking hospitals with LTC homes, we can innovate new and better ways of organizing care," says Leis. "We stop working across silos and start to see what is possible when we team up with a shared focus of providing resident-centred care."
The PROMPT-LTC trial included multiple hospital sites and academic partners, including Sunnybrook Health Sciences Centre (Toronto), Michael Garron Hospital (Toronto), Humber River Health (Toronto), Baycrest (Toronto), JC Wilt Infectious Diseases Research Centre, National Microbiology Laboratory (Winnipeg) and U of T's Dalla Lana School of Public Health, Temerty Faculty of Medicine and the Centre for Quality Improvement and Patient Safety.
