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New program eases patient transition from hospital to home

by Osler Staff | Aug 02, 2017



A program dedicated to supporting patients who experience social, language and cultural barriers has begun at Osler. The Post-Discharge program was developed in partnership with Polycultural Immigrant and Community Services to help patients find community support after they are discharged from the hospital.

After finding success as a pilot project at Etobicoke General, the Post-Discharge program has been extended to Osler’s Brampton Civic and St. Joseph’s Hospital in Toronto.
Through the program, staff provide the tools patients need to maintain their health and quality of life when they return home. Along with offering referrals to community services specific to the patient’s needs, staff also provide reminders and friendly support by phone and in person. 

The program is helping to minimize barriers for vulnerable seniors, those without insurance and newcomers to the country. Many of these patients are at a higher risk for being readmitted, have longer hospital stays and have difficulty finding language and culturally appropriate support after being discharged.

In the pilot year alone, Osler and Polycultural helped 78 individuals through the program and have already begun to facilitate faster discharges and smooth the transition between moving from hospital to home.

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