Improving Care Transitions


Despite (or maybe because of) the exceptional work by nurses and other health professionals, hospitals are the most expensive setting to receive health care.

Leaving the hospital – welcomed by patients, families, and health care professional – can often be a source of additional risks and poor health outcomes, leading to additional costs.


In a new paper, the University of Michigan’s Center for Healthcare Research and Transformation argues that poorly coordinated care transitions between hospitals and other care settings may cost an estimated $12 to $44 billion per year.


These costs are often more than just figures in a budget. They represent additional discomfort, diminished quality of life, and unnecessary stress for patients and their families.


The report outlines several best practices to improve care transitions, many of which rely on the core competencies of nursing practice. CHRT recommendations include:


Comprehensive Discharge Planning: Examining patient needs, social support, and reconciling medication orders is essential to improving outcomes. Follow up phone calls with patients several days after discharge is also essential to improve positive outcomes.


Better Communication with Patients and Between Providers: Improving communications between clinicians and patients and families is essential. Open and more thorough communication between providers is also critical to reducing the risk of medical errors.


Enhanced Patient Education: Evidence-based techniques, like the “teach back” method can improve the ability for patients to understand complex and unfamiliar care instructions.


These efforts can go a long way to improving the care transitions for patients, families, and health care professionals. The full report is available here.

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