Care Transition Program

The Care Transition Program is a partnership with the North East Local Health Integration Network (NELHIN) and Health Sciences North designed to help patients who have been discharged from the hospital and have a high probability of being readmitted. As part of the program, community paramedics visit patients in their homes to help them manage their health. Most participants have one or more chronic diseases that they need help managing. Paramedics schedule regular visits with patients in their homes to assess their health, reinforce care plans, help them manage their condition and emphasize the importance of taking their medication properly. Paramedics may conduct unscheduled visits when patients symptoms worsen and provide them with treatment that can decrease visits to the hospital. The program runs 12 hours a day, seven days a week with one paramedic on duty who works under established medical directives with physician oversight. Eligibility In order to enrol in the program, patients must be referred by a doctor upon discharge from the hospital or emergency department. Program Benefits The Care Transition Program improves the quality of life for many senior citizens in the community and enables them to manage their health while living independently in their own homes. It provides additional support to individuals with chronic health issues to help reduce the chances of them needing to be readmitted to the hospital.

In order to enrol in the program, patients must be referred by a doctor upon discharge from the hospital or emergency department.

Use the website.

Website

https://www.greatersudbury.ca/live/emergency-services/paramedic-services/community-paramedicine-programs/