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Transitions of Care

AHRQ’s tools and research to ensure safe and seamless transitions of patients from one care setting to another, reducing preventable adverse events, drug-related errors, and other problems.

Tools

TeamSTEPPS® Module on Communication

Toolkit to Engage High-Risk Patients in Safe Transitions Across Ambulatory Settings

Care Transitions from Hospital to Home: The IDEAL Discharge Planning

MATCH Toolkit (Medications at Transitions and Clinical Handoffs)

Taking Care of Myself: A Guide for When I Leave the Hospital (PDF, 794KB)

Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families, Warm Handoffs

I-PASS: Integrating High Quality Handoffs into TeamSTEPPS and Hospital Care (Video, 59 minutes, 23 seconds)

Improving Provider Communication to Improve Transitions in Patient Care: Health IT Success (Video, 6 minutes, 3 seconds)

Research

Making Healthcare Safer III: A Critical Analysis of Existing and Emerging Patient Safety Practices, Chapter 15. Care Transitions (PDF, 414 KB)

Potentially Preventable Readmissions: Conceptual Framework To Rethink the Role of Primary Care: Final Report

Care Transitions-related projects funded by AHRQ's Division of Digital Healthcare Research

AHRQ Director Gopal Khanna's video on the new challenge to address care transitions with digital solutions (Video, 1 minute, 41 seconds)

The Role of Health IT to Improve Care Transitions (Video, 1 hour, 25 minutes, 54 seconds)