Transitions from Hospital to Community
The Network works to ensure smooth transitions from acute and community hospitals to inpatient rehab hospitals and to community-based services.
Enhancing transitions from hospital to community is an ongoing focus for the Network and its members. Together, we work to connect people to the appropriate community supports and services following an acquired brain injury.
As a result of this work, the following were produced to inform transitions:
- A regular report on current wait times for ABI community services to support transition planning and help clinicians, patients, families and caregivers plan and make decisions about ABI services.
- A best practices guideline for planning hospital to community transition for individuals with acquired brain injury. The guideline provides interprofessional teams with a clear set of best practices that take into account the unique needs of individuals with a brain injury and their caregivers.
The ABI Network’s 2021-2024 Strategic Plan continues to focus on the patient/client experience through the promotion and support of seamless client navigation. Over the next three years we will:
- Demonstrate the effectiveness of our member partnerships in system navigation through a central point of access.
- Enhance ease of use, relevance and timeliness of ABI Network resources and communications
- Engage Ontario Health Teams (OHTs) to raise awareness of ABI, of the ABI Network and specialized services/organizations available to inform integrated care planning.
- Facilitate access to information on leading practices to implement or access virtual care for individuals with brain injury.