Discharge Management Services
Hôpital Montfort has a team of nurses who coordinate and plan the discharge of patients.
The nurses in Discharge Management Services use an interdisciplinary approach to ensure that the discharge plan is appropriate to the needs of each and every patient. The nurses consult the patient, the family, their social network, the medical team and the interdisciplinary team in order to develop an appropriate discharge plan.
Development of a personalized discharge plan is mostly based on communication between the admitted patient and his or her family/social network. Upon admission, the patient and/or family members must inform the medical team of any existing or potential problems or concerns that could prevent the patient from returning home after discharge.
The early identification of factors that may hinder a patient from returning home allows the Discharge Management team and other health professionals to develop a plan that will best meet the needs and expectations of the patient and his or her family.
In order to ensure the continuity of care after discharge, the Discharge Management team works closely with community agencies and other partners throughout the region.