On-site rapid testing leads to decrease in emergency department visits among long term care residents

HN Summary

• A Canadian study found that on-site rapid testing for COVID-19, influenza and RSV in long-term care homes reduced emergency department transfers by enabling earlier diagnosis and treatment. 

• The PROMPT-LTC trial showed that residents received test results in under an hour, leading to more frequent testing, faster antiviral treatment and improved outbreak detection compared to traditional lab testing. 

• Researchers estimate that expanding on-site rapid testing across Canada could prevent approximately 8,000 emergency department visits each respiratory virus season, improving resident care while easing pressure on hospitals.

A study led by Sunnybrook Health Sciences Centre, Michael Garron Hospital, and Humber River Health, 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 seniors living in LTC homes.   

During the COVID-19 pandemic, gaps in Infection Prevention and Control (IPAC), 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 Dr. Jerome Leis, Medical Director of Infection Prevention and Control at Sunnybrook Health Sciences Centre and co-principal investigator of the trial. “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 a world first. Using a desktop rapid testing instrument that can be operated by trained LTC staff, LTC homes were able to identify positive cases of COVID-19, influenza, and RSV in under an hour compared to the usual three-to-five-day turnaround when this testing relies on transporting specimens off-site to a local 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, while the remaining 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. This gap is addressed with on-site testing leading to better surveillance and case detection by LTC homes,” says Dr. Leis, also an associate scientist at Sunnybrook Research Institute.     

The improved detection of respiratory infection translated to better outcomes for residents, including an 11 percent lower chance of being transferred to a hospital emergency department for complications of a respiratory infection.  

IPAC teams from each of the four hospital sites trained LTC home staff to integrate on-site rapid tests into their workflows, enhancing staff education and capacity building.   

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.  

“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 Dr. Leis.      

 The research team predicts that if this approach were used nationally across Canada, it 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.

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