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Transitional Care/After Care

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  • Topic: Transitional care/after care
  • Topic: Medical treatment facilities
By Topic
  • Hospitals and hospital systems (13)
  • Discharge from health care facility (7)
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Englewood Hospital & Medical Center

September 1, 2006 | Toolkit

Standardized forms were created by the hospital for patients admitted to the hospital from the emergency department (ED).

Quality and Cost Analysis of Nurse Staffing, Discharge Preparation, and Postdischarge Utilization

April 21, 2011 | Journal Article

Investments in nursing care hours reduce hospital readmissions by better preparing patients for discharge.

Nurse Identified Hospital to Home Medication Discrepancies

May 1, 2010 | Journal Article

In this study, nurse interventionists identified and documented medication discrepancies from two Inland Northwest hospitals. The researchers identified more system-level discrepancies than patient-level ones.

Palliative Care in Long-Term Care

February 1, 2010 | Journal Article

Academic and medical professionals discuss the transition from palliative care in hospitals to nursing homes.

Expecting Success: Excellence in Cardiac Care

National Program

Expecting Success was a national program aimed at improving the quality of cardiac care while reducing racial, ethnic and language disparities.

When Students Have an Emergency, the Brookline Resilient Youth Team Steps in

April 18, 2011 | Program Result Report

In 2004, the Brookline Community Mental Health Center and Brookline High School established the Brookline Resilient Youth Team. It provides counseling and academic help to high school students who are re-entering school after a personal emergency.

Connecting Hospitalized Patients One-on-One with Other Patients Who Have the Same Illness

May 11, 2009 | Program Result Report

From 1994 to 2007, staff at Friends' Health Connection (originally called Long Distance Love), New Brunswick, N.J., created and ran a program that enables hospitalized patients to communicate one-on-one with another patient who has the same illness.

Section 5: How-To Guides

February 4, 2009 | Toolkit

How-to guides supported through TCAB, a national program of RWJF and the Institute for Healthcare Improvement, offer detailed steps to implement select aspects of the program.

Discharge Nurse Position Description

June 4, 2008 | Toolkit

Staff at the University of Texas M.D. Anderson Cancer Center, Houston, Texas, began using an experienced nurse to support the clinical nurses by coordinating discharge activities, serving as a liaison to other team members and ensuring that all aspects of discharge are complete for patients and families.

Heart Failure Encounter Form

June 1, 2008 | Toolkit

An off-site, nurse-led heart failure clinic was created to help heart failure patients better control and self-manage their disease post-hospitalization.

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