Working with our partners to take patients from Hospital to Home

Sometimes when patients return home from the hospital, they need a little bit of extra support. In December, the Central West CCAC began working with our partners at Headwaters Health Care Centre (Headwaters) and William Osler Health System (Osler) – as well as the Ontario Telemedicine Network (OTN) and the Central West Local Health Integrated Network (LHIN) – to meet this need by launching a program called Hospital to Home (H2H).

H2H is an innovative new way we are working together to improve clinical handoffs and information sharing when patients leave hospital and re-enter the community. This means that patients continue to receive short-term nursing care from the same team, made up of H2H nurses hired by the Central West CCAC, after they return home. The program currently supports patients with cellulitis and urinary tract infections (UTI) but will later expand to help those with more complex needs.

Last month, H2H launched at Brampton Civic Hospital after originally launching at Etobicoke General Hospital in December and then at Headwaters in January. This full complement of H2H sites ensures that patients can receive coordinated care from the same team whether in hospital or at home.

The goal of H2H is to help prevent unnecessary hospital admissions, shorten the length of stay for admitted patients, provide greater continuity of care and ultimately, enhance the patient experience for those we serve.

H2H is an excellent example of how different organizations from across the continuum of care can work together to improve access to services that truly benefit patients. Since its launch, more than 135 patients have been enrolled in the program and dedicated H2H nurses have completed over 750 nursing visits in the community.

The project team gathered feedback from staff and patients at each phase of the rollout to help shape the program even further. So far, feedback to date has been overwhelmingly positive. Here’s what some H2H patients had to say:

  • I received outstanding care!”
  • My experience was fantastic. Each Nurse was extremely knowledgeable and they arrived in the timeframe as promised.”
  • “I really appreciate this program. You took the time to talk with my wife and comfort her when I did not know what to say to make her feel better.”
  • “You hired the best nurses for the job. They have all been wonderful!

These incredible comments are proof positive that the H2H is one more way the Central West CCAC, with our hospital partners, is providing outstanding care to every person, every day.

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