title: MI system leads in effort to improve transitions.
abstract: In discharging patients, use a risk assessment tool to identify at-risk patients. Create interventions based on findings from screening tool: Multidisciplinary collaboration is key to positive discharges.
mesh_terms: D000046:Academic Medical Centers; D003266:Continuity of Patient Care; D003299:Cooperative Behavior; D006801:Humans; D008824:Michigan; D019982:Organizational Case Studies; D010351:Patient Discharge / Q000592:standards; D010360:Patient Transfer / Q000592:standards*