title: Readmission project aims to smooth transitions.
abstract: WellStar Health System in suburban Atlanta partners with post-acute providers to improve transitions in care and reduce readmissions. - Staff holds regular meeting with post-acute providers. -Team collaborates on smoothing transitions. - CMs work with facilities to take back patients after ED visits. -Transition coach follows patients after discharge.
mesh_terms: D019090:Case Management; D003266:Continuity of Patient Care / Q000592:standards*; D005845:Georgia; D006801:Humans; D019982:Organizational Case Studies; D010351:Patient Discharge; D010359:Patient Readmission