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Hospital Discharge/Transfers

Hospital Discharge and Transfers

shutterstock_58595401After surgery or hospitalization, home care may be needed on a temporary or long term basis. We regularly work with hospitals, assisted living, long term care facilities, rehab centers and private care providers to coordinate safe and seamless transitions for their patients when they leave one setting to go to another.

Our qualified team of admission nurses will collaborate with all caregivers involved to manage multiple, complex medical conditions and ensure a smooth transition for the patient and their family. We will even come to the hospital prior to your release to collect important information to ensure continuity of care, including making arrangements for home medical equipment.

We believe that thorough communication and coordination of care can potentially reduce preventable hospital readmissions. This is accomplished through:

  • A full review of discharge information, especially the diagnosis and the implications of prescribed medications and treatments in the home.
  • A review of potentially serious complications associated with the patient’s medical conditions or prescribed treatments.
  • An evaluation of the patient’s support network.
  • Reconnecting the patient with his/her family physician and other healthcare providers.

Our hospital discharge and transfer program gives our patients and their families a high degree of satisfaction and confidence that their clinical concerns have been appropriately considered in order to make a successful transition.