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What is Transitional Care?

With regards to transitional care or transitional medicine, this is in reference to the coordination and the continuity of health care throughout movement from a particular healthcare setting to a new facility or it could also be that they are moving the patient back to their home. Well basically, this is referred to as the transition between health care practitioners and establishments for the reason that both of their care and condition is changing while facing acute or chronic illness.

Seniors who are suffering from wide varieties of health conditions are typically in need of health care services in various settings in order to meet their specific and varying needs. But things are a little bit different for younger patients since the focus here is more on how to move adult to child health services successfully.

As per the American Geriatrics Society or AGS, they define transitional medicine as a series of actions meant to guarantee the coordination and the continuity of health care as patients are being transferred between locations or on different levels of care in the same facility or location. Representatives do include but not limited to sub-acute as well as post-acute nursing homes, hospitals, primary and specialty care offices, patient’s home and even long term care facilities.

And for transitional care, this is mostly about comprehensive plan of care and also, the health care practitioner’s availability and if they’re trained in relation to handling chronic care. It is not the only thing that should be met because for the practitioners, they need to have updated information about the patient’s preferences, goals and their clinical status too. This additionally includes the education of family and the patient, logistical arrangements and coordination among healthcare professionals involved during the transition.

While on transition phase, the patients who receive more complex medical care which is typically older patients are at greater risks of poorer outcomes due to communication errors and/or medication errors among healthcare providers and between patients/family caregivers and providers involved. Many of the studies done in the area of transitional care looked further in the transition from hospitalization to the next provider setting which is usually rehab center, sub-acute nursing facility or home either with a professional homecare service or none. And in relation to the poor outcome of the transition, this mostly includes temporary or even permanent disability, recurrence or continuation of symptoms and worse, death.

Healthcare utilization outcomes for the patients who are experiencing poor transitional medicine which includes returning to emergency room or perhaps, readmission to the hospital. Due to the reason that there’s a constant rise in healthcare expenditure at unpredictable rate, there’s increased focused on providers, policymakers and patients on restraining unnecessary use of resources.
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