Supporting Care at Home

Capitalizing on the many lessons learned from the Pandemic, Halton Healthcare recently launched its new Remote Monitoring Program at all three of its hospitals. This new initiative is an enhanced version of the organization’s very successful COVID Care at Home Program – an initiative developed during the early waves of the pandemic to discharge recovering COVID-19 patients home safely by closely monitoring them. Bolstered with advanced remote monitoring and bluetooth technology, the new Program has been expanded to include patients in Halton Hills, Milton and Oakville with congestive heart failure, chronic obstructive pulmonary disease and other respiratory illnesses.

Working closely with the patient’s care team, a Rapid Response Nurse coordinates with Halton Region Community Paramedics and Mississauga Halton Home and Community Care Support Services to organize in-home monitoring and care customized to the individual needs of each patient.

Patients referred to the program by a physician are provided with a monitoring kit and bluetooth enabled tablet that connects to the Halton Healthcare Remote Monitoring team. The paired tablet records vital information, such as heart rate, blood pressure, oxygen levels and weight, and is shared directly to the remote monitoring team.

"We can see each patient’s dashboard of their daily vitals sign. If any patient’s readings is unusually high or low, a clinician from our Remote Monitoring Program will immediately check in on them through a face to face video call,” says Carleen Shipley, Halton Healthcare Nurse Navigator. “It is easier to engage and involve patients in their care plan when we can see each other on a video call, especially when patients are being oriented to the program or when they are not feeling well.”

A Rapid Resource Nurse from Home and Community Support Services also checks in on each patient within 48 hours of their referral to the program. If the patient is being discharged on oxygen, a Respiratory Therapist from Halton Healthcare’s C. Air Home Oxygen Program will ensure an easy transition home by providing the proper equipment, oxygen, and education on how to self-monitor. Should the patient’s condition change, an immediate assessment can be provided in the patient’s home.

Patient satisfaction with the COVID Care at Home program prompted the organization to expand the program to include patients with other respiratory illnesses. Feedback from patients and their families has been positive with most noting the sense of security knowing that someone is available to help them, and that they can be a partner in their own care. With the continuous access to support, patients will be cared for and are able to recover in their own homes, requiring fewer visits the Emergency Department and avoiding unnecessary hospital stays.

“These recovering patients may be scared and anxious. This program allows us to harness technology that connects them with their healthcare team, so we can guide their treatment along with them from inside the comfort of their homes,” explains Dr. Stephen Chin, Chief of Hospital Medicine, Oakville Trafalgar Memorial Hospital. “Patients also know how to access the program through a 24/7 emergency number so they can get immediate help instead of having to go to the Emergency Department.”

The Remote Patient Monitoring Program is the result of the tremendous collaborative efforts of Halton Healthcare, Mississauga Halton Home and Community Care Support Services, Halton Region Community Paramedics, C.AIR Home Oxygen Program and the Connected Care Halton Ontario Health Team.