Supporting Patients & Families Through Hospital Transitions
“Every transition is a moment of vulnerability—but also an opportunity for care, dignity, and clarity.”
During Your Hospital Stay (ER, ICU, Surgery, or General Floor)
Know the Basics
- Do I understand the current diagnosis and treatment plan?
- Do I know which team or provider is in charge right now?
- Have all my questions or concerns been addressed before the next move?
Keep Track of Personal Belongings
- Are essential items (glasses, dentures, hearing aids, phone, charger) safely labeled and documented?
- Do I know where my belongings will go during a transfer?
- Has a family member been asked to safeguard key items if needed?
Stay Informed
- Have I been told clearly where I’m being moved to—and why?
- Has my family or caregiver been updated about the move?
- Do I need a translator or help because of hearing, memory, or cognitive issues?
During a Move Between Departments or Units
Ask and Confirm
- “Where am I going next, and why?”
- “Who will be my new care team?”
- “Will my family be notified right away when I arrive?”
Keep Essentials With You
- Glasses, hearing aids, phone, and any comfort items
- Notebook with names, dates, and instructions so it stays with me
Handoff Awareness
- Has the nurse or provider given a bedside handoff to the next team?
- Were my medications, allergies, and care needs reviewed during that handoff?
Before Discharge (Home or Another Facility)
Understand the Plan
- Do I have clear instructions for:
• Medications
• Diet restrictions
• Wound care (if needed)
• Follow-up appointments - Have I received all of this in writing or electronically?
- Do I know who to contact if I have questions or symptoms?
Tools & Access
- Do I have access to the patient portal or a printed summary of results and instructions?
- Have I been shown how to use any new medical equipment (walker, glucometer, oxygen, etc.)?
Advocacy & Empowerment
For Patients & Families
- Have we asked for help if English isn’t our first language?
- Have we spoken up if something doesn’t seem right or clear?
- Do we feel confident about the next steps—or do we need more explanation?
For Caregivers
- Do I understand my role after discharge?
- Have I been included in planning and teaching before my loved one goes home?
- Am I supported—emotionally and logistically—in managing their care?
Final Note:
A care transition is more than a move—it’s a handoff of safety, healing, and trust.
Speak up. Take notes. Ask for clarity. You are part of the care team.