Case Management

Case management Q&A

Case Management Weekly, July 25, 2012

Q. How does transitional care differ from discharge planning? 

A. The focus of transitional care is self management. The treatment team makes discharge arrangements and establishes discharge orders without necessarily knowing much about what the patient and family can do. 

A transition coach or nurse focuses on what the patient and family need to do after discharge. In learning what a family currently does at home, a transition coach or nurse can provide valuable input into a discharge plan. However, a transition coach or nurse is not responsible for making necessary arrangements. The relationship continues when the patient returns home, where much is learned about what is really happening with respect to self care. 

Editor’s note: This week’s Q&A is adapted from Reducing Readmissions: A Blueprint for Improving Care Transitions published by HCPro, Inc.

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