Transitions of Care
Care after Treatment at ACUTE
ACUTE is committed to safely returning patients to their referring providers upon medical stabilization.
If a patient does not have an established treatment team, or it is determined that they may benefit from an intermediate level of care to maintain medical stability gains, ACUTE can make expert referrals to this end.
Thoughtful, Compassionate Transitions
“Transitions of care” refer to the movement of patients between health care practitioners, settings and home as their condition and care needs change. Effective transitions of care have been shown to reduce both readmission rates and adverse events.
ACUTE is committed to fostering safe, collaborative transitions when patients achieve medical stabilization and must go onto further treatment. This involves:
Advance planning
Throughout a patient’s stay at ACUTE, we engage a dedicated social worker as part of the treatment team to oversee risk assessment and develop a discharge plan that meets each patient’s unique medical and behavioral recovery needs.
Clear communication
Most medical errors involve miscommunication during the hand-off between providers, especially when external specialists are involved in medical care.
Engaging patients, families and caregivers
Hospitalization and transitions are inherently stressful. To minimize conflicting recommendations, confusing medication regimens and unclear instructions about follow-up care, ACUTE engages all stakeholders in discharge planning through compassionate conversations accompanied by clear, written plans.
Written treatment summaries and discharge plans
ACUTE clearly communicates information about patients’ medical conditions and outlines an ongoing plan of medical support. ACUTE is always available to provide consultation to receiving treatment centers and providers to ensure they feel confident following the care plan and have the knowledge or skills to do so.
Feedback opportunities
Our team of social workers utilizes a timely post-discharge protocol to ensure receiving Residential Treatment Centers, programs and providers admit patients safely and feel confident in their ability to maintain medical stability as recovery progresses. Additionally, our Provider Relationship Managers offer opportunities for receiving treatment programs to provide feedback about their experience collaborating with ACUTE. Lastly, ACUTE’s dedicated After Care Clinician follows up with patients at regular intervals to ensure they are progressing in their recovery and connect them with any additional support or resources they may need.