For heart failure patient Timothy Fountain, the opportunity to spend part of his recovery at home was a blessing.
Earlier this summer, as Timothy was leaving a park after an evening of fishing, he struggled with shortness of breath. The next morning, a walk down the stairs and back up left him breathless.
Timothy, 38, was diagnosed with heart failure on July 1 and four days later had a Left Ventricular Assistive Device (LVAD) surgically implanted.
An LVAD functions as a mechanical heart for those diagnosed with end-stage heart failure. Implanted through open heart surgery, the LVAD assists the heart to pump and circulate blood while patients are bridged to transplant or destination therapy.
Timothy was the beneficiary of a new collaboration between the Peter Munk Cardiac Centre (PMCC) and Saint Elizabeth Healthcare (SEH), helping LVAD patients get home sooner.
LVAD patients typically spend four weeks in the hospital during postoperative recovery – sometimes even longer. The goal of the collaboration between PMCC and SEH is to reduce the patient's length of stay and readmission rates as well as improve the transition home.
"Heart failure patients typically spend a long time in hospitals before getting the LVAD," says Marnie Rodger, nurse practitioner at PMCC. "This collaboration will allow them to leave the hospital a little earlier after surgery and be comfortable in their own home, while still receiving the care they need."
Working with LVAD patients for more than 15 years, Marnie is their first point of contact; she answers their questions, shows them the device and explains how it works. She also helps patients and family members understand how the LVAD will impact their day-to-day life.
After the LVAD is surgically implanted, patients spend about two weeks recovering at PMCC, and then two-to-three weeks recovering at home under the care of SEH.
The SEH team, compromised of nurses, physiotherapists and occupational therapists, received training at PMCC to ensure they were familiar with the LVAD patient population.
"It gives the patients comfort and ease to know when they go home, the nurses taking care of them know the device," says Marnie, who led the training.
Nurses will go into the patient's home each day to perform various assessments. The team learned several different tasks specific to the LVAD population, including taking blood pressure manually, looking for complications, inspecting the driveline site for infections and ensuring the family is comfortable changing surgical dressings.
PMCC originally piloted the partnership back in 2017, successfully sending three patients home early. To continue with the implementation, the Local Health Integration Network (LHIN) required that PMCC apply to become an approved agency to provide community support services under the Home Care and Community Services Act.
Under the Public Hospitals Act, hospitals are not allowed to provide homecare services to patients. Any organization that wants to provide or arrange homecare must be approved for community status by the Ontario Ministry of Health and Long-term Care and LHIN.
Joan Comendador, Project Manager for PMCC, played a large role in securing the status.
"It was really exciting when we finally were approved," says Joan. "Watching the whole process – from getting the interprofessional team together, brainstorming what's best for the patients and now seeing it being implemented – is quite rewarding."
And for Marnie, even when patients go home, she's still there to support them during their recovery.
A remote patient monitoring app developed by SEH, called Medocity, can send Marnie a notification if the patient develops any worrisome symptoms. It also allows patients to ask Marnie questions, helping reduce readmission rates.
"Even when they're at home, we can always keep a close eye through the app," says Marnie. "In a time of shrinking budgets, it really is important to try and reduce a patient's length of stay.
"Not only is it great financially for us, it's also good for the patients.
"And at the end of the day, it's really all about the patients."