title: To succeed, hospitals improve transitions of care.
abstract: The emphasis on preventing readmissions and emergency department visits after patients are discharged from the hospital makes it imperative for hospitals to improve transitions from one level of care to another. Communication between levels of care is essential. Patients and family members should be involved in planning for post-acute care. Case management departments should be adequately staffed so case managers can spend the time necessary to ensure a successful discharge. Follow up with accepting facilities and patients and families ensures a smooth transition.
mesh_terms: D019090:Case Management / Q000458:organization & administration* / Q000592:standards; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000191:economics / Q000592:standards*; D006801:Humans; D058991:Patient Protection and Affordable Care Act / Q000191:economics / Q000592:standards*; D010359:Patient Readmission / Q000191:economics / Q000592:standards; D018802:Patient-Centered Care / Q000458:organization & administration* / Q000592:standards; D011785:Quality Assurance, Health Care / Q000379:methods; D012051:Reimbursement Mechanisms / Q000331:legislation & jurisprudence / Q000639:trends; D014481:United States