Rapid Onsite Testing Reduces Emergency Department Transfers in Long-Term Care

Respiratory infections in long-term care residents frequently trigger emergency department transfers that strain hospital capacity and expose frail patients to additional risks. Turnaround delays from off-site laboratory testing hinder rapid diagnosis and outbreak control in these congregate settings. These system gaps are most consequential during peak virus seasons when clinical deterioration can be swift. To help address this challenge, academic hospitals in Toronto and partners have evaluated onsite rapid testing within long-term care homes.

The intervention was assessed in the PROMPT-LTC trial, led by Sunnybrook Health Sciences Center with Michael Garron Hospital, Humber River Health, and the University of Toronto in partnership with 20 long-term care homes across Toronto. Published in JAMA Internal Medicine, the study used a desktop rapid-testing instrument operable by trained staff to detect COVID-19, influenza, and respiratory syncytial virus in under an hour. This contrasted with the usual three- to five-day turnaround when specimens were transported to external laboratories.

The trial was conducted during the 2024–2025 respiratory virus season. Half of the homes implemented onsite rapid testing, while the remainder continued standard off-site testing. Infection prevention and control teams from each hospital trained long-term care staff to integrate the testing into daily workflows; Baycrest served as one of the implementation sites.

Homes with onsite rapid testing performed more than twice as many tests and initiated influenza antivirals earlier. This improved detection translated into an 11% lower chance of transfer to a hospital emergency department for complications of respiratory infection, equivalent to four avoided emergency department visits per 100 beds over a respiratory virus season. According to the research team, if applied across Canada, the approach could avert an estimated 8,000 emergency department transfers between November and March, when hospitals are often overcrowded.

“Bringing hospital-level testing into LTC homes is a major improvement in quality of care for residents. Knowing that this approach improves resident outcomes and can free up health care capacity should justify the upfront cost,” said 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.

“Bringing hospital-level testing into LTC homes is a major improvement in quality of care for residents. Knowing that this approach improves resident outcomes and can free up health care capacity should justify the upfront cost,” said 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.

"By working across the health care sector and linking hospitals with LTC homes, we can innovate new and better ways of organizing care. We stop working across silos and start to see what is possible when we team up with a shared focus of providing resident-centered care," said Leis.