Services

Recovery after discharge

Recovery pathways in development

Medical care and rehabilitation, designed to work together

Recovery does not end when you leave hospital. We are developing pathways that bring medical follow-up, rehabilitation, and allied health together. The planned focus includes recovery after surgery, critical illness, neurological injury, and trauma. Eligibility, availability, and access arrangements will be confirmed for each pathway.

After surgery

Medical reassessment and rehabilitation to support recovery, everyday function, and the next stage of care.

After critical illness

Coordinated support for physical, cognitive, respiratory, nutritional, and psychological recovery after intensive care.

After neurological injury or trauma

Rehabilitation and recovery support after hospital care, bringing relevant disciplines together around your needs.

These recovery pathways are in development. More information is coming soon.

Why Avalon?

Canadian research informs the coordinated, interdisciplinary care we are building at Avalon.

Click or tap a square to explore the studies.

Recovery and independence

After stroke: An Ontario randomized trial found better patient-reported physical functioning and care experience at six months with coordinated transitional care.

For older adults: Québec’s PRISMA study associated coordinated regional services with less functional decline.

With chronic pain: In a study, participants completing an intensive Toronto-area interdisciplinary pain program reported less interference with daily activities.

After surgery: A Toronto study associated integrated hospital-to-home care with shorter average hospital stays and a lower risk of emergency visits in selected thoracic surgery groups.

Symptoms and patient experience

COPD symptoms and health status: In an Ontario randomized trial, patients with high-risk COPD receiving integrated disease management had better COPD-related health status after 12 months than those receiving usual care.

Patient experience: In a separate BC specialist team-care pilot, 95.3% of 490 survey respondents were satisfied or very satisfied with their care.

Clinician experience

Specialists in a small BC team-care pilot reported better workload management, less electronic medical record work at home, and improved job satisfaction. Some administrative staff reported increased workload and stress, highlighting the importance of supporting the whole team.

System efficiency and costs

Stroke discharge care: A Montréal randomized trial of 114 patients reported approximately 30% lower average health system costs through three months with early supported discharge and home rehabilitation.

COPD transition care: An Alberta economic model estimated $5,416 lower health system costs per patient than usual care for a COPD discharge program, including the initial admission and 90 days after discharge, in 2019 Canadian dollars.