Patient- and Family-centered Care Coordination Practices

Following are some practices that will increase rates of screening, counseling, referral, and follow-up of recommended services to improve patient safety and care:

• Warm hand-offs in the referral process from one team member to the next and from primary care to specialty care. This process helps prevent communication breakdown by partnering with the family in what is being discussed about the clinical problem, current status, and plan of care.
• Ways to help families navigate effectively across healthcare entities with clear accountability and responsibility among all parties. 
• Reminder and recall interventions to ensure that recommended referrals, tests, and follow-up appointments are completed on a timely basis.