Care transitions have been described as a bridge connecting patients from one healthcare provider or group of providers to another. It’s easy to imagine a grand structure, like the Golden Gate Bridge in California, with awe-inspiring towers, powerful suspension, and a rock-solid foundation. But, when patients are discharged from the hospital, the bridge they must cross looks much different: rickety, narrow, and unstable, with wide gaps between decaying foot-boards. Patients who haven’t fully regained physical or cognitive health, are physically vulnerable, and often have no social support and a host of other challenges can easily end up falling through the bridge’s cracks.
To improve care transitions and prevent readmissions, the healthcare community must build a better bridge. This webinar describes consequences of poorly managed transitions of care, explains factors contributing to care transition adverse events and readmissions, compares established care transition models for improvement, and describes the 10 components of the Ideal Transition in Care that represent structural supports needed for a bridge leading to improved outcomes and fewer readmissions.