title: My say: patients are still falling through the cracks in the healthcare maze, and proactive discharge planning can help.
authors.forename: Patrice D
authors.initials: PD
authors.lastname: Artress
mesh_terms: D003152:Community Health Nursing / Q000458:organization & administration*; D003266:Continuity of Patient Care / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D010351:Patient Discharge; D012017:Referral and Consultation / Q000458:organization & administration*