Transitional Care
The movement patients make between health care practitioners and settings as their condition and care needs change during course of a chronic or acute illness
Transitional care programs are especially important for patients with chronic illnesses, complex medical needs, or those at higher risk for complications. They can improve patient outcomes, enhance the patient experience, and contribute to cost savings in the healthcare system by reducing unnecessary hospitalizations and emergency department visits.

We Believe We Will Be Successful If Our Clients Are Successful.
Care Coordination
Healthcare providers work together to plan and manage the transition, ensuring that the patient's needs are met. This involves effective communication among doctors, nurses, therapists, and other healthcare professionals.
Medication Management
Ensuring that patients understand their medications, know how to take them, and have access to their prescriptions is crucial in preventing medication errors and complications.
Education and Patient Empowerment
Patients and their caregivers are educated about their conditions, treatment plans, and what to expect during and after the transition. Empowering patients with knowledge and self-care skills can improve outcomes.
Follow-Up Care
Scheduled follow-up appointments and monitoring are important to track a patient's progress and address any issues that may arise after the transition.
Home Care Services
In many cases, patients require support at home, such as home health services or assistance with activities of daily living. Transitional care may involve arranging for these services.
Patient and Family Involvement
Engaging patients and their families in the transition process and decision-making can lead to better outcomes and increased patient satisfaction.
Communication
Effective communication between healthcare providers, patients, and their families is critical. This includes sharing medical records, care plans, and important information to ensure everyone is on the same page.
Preventing Readmissions
One of the primary goals of transitional care is to reduce hospital readmissions, which can be costly and detrimental to a patient's health. By addressing the factors that contribute to readmissions, such as medication errors or inadequate follow-up care, transitional care programs aim to lower these rates.