High quality care transitions

"This report aims to improve the safety of care transitions across the entire continuum of care by focusing particular attention on a relatively neglected aspect of care transitions: the appropriate roles and responsibilities of ambulatory practices (i.e., outpatient clinics and other similar settings) 
in ensuring the safety of patients transitioning in and out of inpatient settings."

There and home again, safely: 5 responsibilities of ambulatory practices in high quality care transitions
PE Sokol, MK Wynia
American Medical Association
March 2013

Read more here.