title: Transition manager is liaison between teams.
abstract: At University of Utah Health Care, a transition case manager acts as a liaison between the outpatient care team at community clinics and the inpatient care team. The transition navigator works with case managers at the hospital and the clinics to make sure both have the information they need to coordinate care for the patient. The transition navigator visits patients in the hospital and works with the unit case manager to make sure the discharge plan will work. To further smooth transitions, the patients receive a one-page sheet that summarizes their discharge instructions, follow-up appointments, and medication regimen.
mesh_terms: D019090:Case Management / Q000458:organization & administration*; D006785:Hospitals, University; D019982:Organizational Case Studies; D010348:Patient Care Team; D010351:Patient Discharge; D010359:Patient Readmission / Q000639:trends; D014589:Utah