Cardiac patients often feel concerned about their recovery and the plan of care they will receive once they’re home. They have questions about symptoms they are experiencing, and can become confused with a long list of medications to take. Managing all of this at home is often daunting and difficult.
In partnership with Saint Elizabeth Health Care, Putting Patients at the Heart (PPATH) cardiac homecare program offers patients and family caregivers around-the-clock support. The program provides easy access to an entire cardiac team after heart surgery, by integrating care between Trillium Health Partners and homecare providers.
“Sometimes your mind plays tricks and you think you’re not feeling that well,” said Nancy Cunningham, a heart surgery patient at Trillium Health Partners. “It’s so reassuring to have someone come in and tell you that you are doing well.”
Once discharged from the hospital, physicians, nurse practitioners, and visiting nurses offer a seamless system of support for 30 days. Within the first 24 hours, an integrated care coordinator visits to ensure the right supports are in place, and the patient record is shared between our hospital and homecare teams so that everyone has access to the same information. This model of care uses the power of teamwork and partnerships to promote better healing and well-being.
On average, PPATH patients can return home one day sooner, supporting a choice to recover at home while opening up hospital beds for other patients in need.
So far, the program has achieved a 28% reduction in post-surgery emergency department visits, a 38% reduction in hospital re-admission rates, and a 98% patient satisfaction rating. It is now the standard of care at our hospital’s regional cardiac surgery centre, and benefits more than 1,000 cardiac patients each year, with annual savings estimated at $950,000.
Putting patient care at the core of this program, and delivering quality and safety across the patient journey, has earned PPATH the CCHL 3M Health Care Quality Team Award for improvement across a health system.
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