Transitional care unit restoring health

Collaborative partnerships are ensuring the success of a care unit at Parkwood Hospital that is easing the strain on acute care beds.

For years hospitals have grappled with the challenge of providing care for patients who no longer need acute treatment, but who must stay in acute care beds because a more appropriate level of care is not available. These patients, who may need more therapy before they can be discharged, or who are awaiting admission to facilities such as a long-term care home, are deemed alternate level of care (ALC). And while they wait, they are occupying much needed beds for new acute care patients who may face a prolonged stay in emergency while awaiting a bed.

At Parkwood, part of St. Joseph’s Health Care, London, the first transitional care unit in Southwestern Ontario is helping to improve the ALC challenge. Acute care patients who require a more appropriate level of care, and who meet the criteria, are admitted to the TCU. Here they receive treatment that restores health, promotes independence and maximizes their potential to be cared for in their own homes with support from the South West Community Care Access Centre (South West CCAC), in retirement homes, long-term care homes, or supportive housing,

“Previously, when I left the hospital, I felt as if an umbilical cord had been cut,” says one grateful TCU patient. “This time I am sure I can go home.”

Collaborative partnerships are the foundation of the TCU’s success. St. Joseph’s Health Care Foundation provided nearly half a million dollars through donor dollars for renovations and equipment, the South West CCAC coordinates admissions and discharges, London Health Sciences Centre refers patients, and the South West Local Health Integration Network provides funding.

Dr. Gordon Dickie, lead physician for the TCU, says, “This role of the South West CCAC is critical to the sustainability and implementation of the TCU care model.” The CCAC case manager, in consultation with the TCU nurse practitioner, screens patients for admission to the TCU. She is also the discharge planner, so helps these patients navigate their journey to better health from acute care to the TCU to their discharge destination.

“We are very pleased to play such a pivotal role in the admission and discharge process of patients in and out of the TCU,” says Sherry Fletcher, regional client services manager, South West CCAC. “The strong relationship we have with our hospital partners has been further enhanced as we’ve worked together to increase patient flow through the system.”

“Over half of the TCU patients we’ve served to date have had their health restored so they feel well enough to go back home,” says Elaine Gibson, vice president, complex, specialty aging, and rehabilitative care at St. Joseph’s. “This is a reflection of the skillful care provided by the TCU team and the collaborative partnership with CCAC.”