Patients and family/caregivers living with advanced life-limiting illness and who are discharged from hospital and require continued palliative home care report negative and stressful experiences when surveyed.
Clinicians, patient experience advisors, and Home and Community Care (HCC) Community Care Coordinators (CCs) describe transitions from hospital to home that did not go well (e.g., delays, incomplete referrals, and lack of information).
This IDEAS team had the following project level aim;
By October 2018, 50% of patients identified as requiring palliative care during a Kingston Health Sciences Centre-Kingston General Hospital (KHSC-KGH) admission and also determined to require continued palliative home care will receive a customized, coordinated and assured discharge plan and handover.