Transition care, also known as transitional care or care transitions, is the the process of managing the movement between varied healthcare environment, without disturbing continuity and coordination thereby preventing adverse events and promote positive outcomes. This process is particularly crucial for individuals transitioning from hospital to home or another care facility, with an interim environment for a gradual and progressive transit, especially those with chronic conditions or following a significant medical event.

Key aspects of transition care:

• Coordination of care:

Transition care involves coordinating services, communication, and information exchange between various healthcare providers, facilities, and the patient’s support system.

• Continuity of care:

It ensures a smooth and seamless transfer of information, treatment plans, and support services as the patient moves between settings, minimizing disruptions in care.

• Patient empowerment:

Transition care programs often include patient education and support to help individuals actively participate in their care and make informed decisions about their health.

• Focus on functional recovery:

For many, transition care aims to help individuals regain functional independence and improve their ability to manage their health independently at home.

• Management of transitions between care settings:

This includes transitions from hospital to home, hospital to rehabilitation facilities, or from one level of care to another within the same facility.

• Management of transitions between different healthcare professionals:

This could involve transitions between primary care physicians, specialists, nurses, therapists, and other healthcare providers.