A key component of coordinating care during transitions includes:

Establishing a multi-disciplinary team is a key component of coordinating care during transitions because it ensures a collaborative approach to patient care. In the context of healthcare transitions—such as moving a patient from a hospital to a rehabilitation facility or from one level of care to another—a multi-disciplinary team can include physicians, nurses, social workers, pharmacists, and other specialists who contribute diverse expertise and perspectives.

This collaborative effort enhances communication and allows for more comprehensive care planning, addressing the various needs of the patient. With each team member contributing their unique skills and knowledge, the transitions can be managed more effectively, reducing the risk of misunderstandings and errors and ultimately improving patient outcomes.

In contrast, relying solely on patient self-reporting may introduce inaccuracies, and communication limitations between facilities can hinder continuity of care. Providing isolated care goes against the principles of integrated healthcare, which emphasize the importance of teamwork and communication in addressing the patient's needs holistically. The multi-dimensional nature of healthcare transitions necessitates a coordinated team approach to ensure effective, safe, and patient-centered care.