Rapid Response Nurses are vital in the CCAC network of health-care services. By smoothing the transition from hospital to home, these nurses act as a bridge to support vulnerable patients with high care needs. Nurses connect with patients within the first 24 hours after the patient is discharged home from the hospital, ensuring the patient is connected to a physician or nurse practitioner and has an appointment within the next seven days.
Rapid Response Nurses work collaboratively with CCAC Care Coordinators and other existing health-care professionals, hospital staff, physicians, nurse practitioners and community agencies to help vulnerable patients - both adults and children - avoid unnecessary emergency department visits and hospital re-admissions following discharge.
Rapid Response Nurses help patients:
- understand their illness and symptoms
- understand their hospital discharge plan
- understand how to take prescribed medications
- arrange for follow-up medical appointments or tests
- connect with their primary care providers, ensuring everyone has necessary information about each step of the patients' journey
- receive appropriate home supports as quickly as possible so that they have everything they need to stay at home safely.
Spotlight on Rapid Response Nurses:
Nataly Model, CCAC Rapid Response Nurse
"As a Rapid Response Nurse, I feel like I can truly help people in the community," says Nataly Model, a registered nurse with more than 11 years of experience in hospital and community nursing.
Nataly tells the story of a recent patient, an 87-year old woman suffering congestive heart failure, whose chronic pain and complex health issues caused frequent hospital visits. The family was overwhelmed and considering long-term care, especially as their mother's behaviour changed and she exhibited confusion, anxiety and memory loss.
Recognizing the patient's symptoms may have been caused by medications she was taking, Nataly advocated for blood work to investigate all possibilities. She called the family doctor and arranged for a lab tech to visit the patient at home. Within days the doctor called back to report Nataly was right – the woman's sodium levels were dangerously low and the most likely culprit behind her symptoms.
The care team now had a more complete picture of the health issues to be addressed and a better chance of connecting the family to the right resources and supports.
"This work opens up more options for a care plan that meets the patient's individual needs and improves her health," says Nataly. "I think our help really improved our patient's and her family's quality of life."